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NERVES  IN   DISORDER 

A    PLEA    FOR    RATIONAL 
TREATMENT 


BT 

ALFRED    T.    SCHOFIELD,    M.D.,    Etc. 

HON.   PHYSICIAN   FRIEDENHEIM   HOSPITAL 


FUNK  &  WAGNAI.I.S  COMPANY 

N:BW   YORK   AND    I.ONDON 


TO 

M    I.  E. 

AND  OTHER   HELPERS 

THIS   BOOK 

IS    DEDICATED 


4.252Q4: 


T 


PREFACE 

HIS   little  book   consists    substantially  History  of 

this  book. 

of  a  lecture  (with  additions)  delivered 
at  the  Sanitary  Institute  twelve  years  ago. 
It  was  printed  at  the  time  by  special  desire 
for  private  circulation.  Now  it  is  entirely 
recast,  and  published  for  the  first  time  in 
response  to  very  numerous  requests. 

Given  originally  to  the  public  in  the  form  Free  from 
of  an  address,  it  was  kept  free  from  needless  caiities. 
and  unintelligible  medical   expressions ;  and 
in   the   additions   needed   to   bring   it  up  to 
date  the  same  style  has  been  preserved. 

It   is   now   published  because  it  is   hoped  Object,  the 
that  an-  earnest  attempt  to  plainly  set  forth  suffering. 
what  Functional    Nerve   Diseases   really  are 
will  dispel  the  ignorance  which  regards  them 
mainly  as  either  shams  or  frauds.     A   short 


viu  PREFACE 

treatise  like  this,  however  imperfect,  couched 
in  plain  phraseology,  may  also  do  something 
to  relieve  those  needless  sufferings  of  nervous 
people  which  are  due  to  a  misapprehension 
of  the  nature  of  the  disease,  coupled  with 
doubts  as  to  its  absolute  reality. 

If  the  causeless  misery  so  frequently  in- 
flicted by  the  patient's  nearest  friends  can 
be  lessened,  as  it  is  hoped,  by  the  reading 
of  this  book,  its  publication  will  be  more  than 
justified.  We  speak  of  "justification"  because 
we  think  this  is  distinctly  needed  in  any 
medical  or  semi-medical  work  brought  before 
the  public. 
Reason  for      ^g  ^  rule,  medical  works  are  for  medical 

publica- 

^'°°*  men,  according  to  the  unwritten  law  of  the 

profession.  But  when  it  appears  possible,  by 
the  diffusion  of  knowledge  and  the  simple 
presentation  of  facts  concerning  nerve  dis- 
orders, to  lessen  and  often  to  end  much 
needless  pain  inflicted  on  these  sufferers, 
and  at  the  same  time  to  inspire  hope  by 
pointing  out  common-sense  lines  of  treat- 
ment, it  is  manifest  that  an  exception  must 


PREFACE  ix 

be    made.  It  is    hoped    that    the    present 

work  may  accomplish  something  towards 
this  end. 

Moreovei  owing   to   the    increased   value  importance 

of  subject, 

of  the  brain  as  distinguished  from  the  rest 
of  the  body  in  the  march  of  civilisation, 
functional  nerve  disease  is  becoming  daily 
of  more  importance,  and  the  recognition  of 
its  nature,  as  well  as  the  value  of  its  early 
cure,  a  matter  of  ever  greater  consequence. 

A  few  simple  hints  on  self-cure  in  slight 
cases,  as  well  as  the  elementary  diagnosis 
of  these  cases,  and  an  outline  of  rational 
medical  treatment,  have  been  given. 

The    treatment    of    functional    nerve   dis-  Old  abuses 

still  exist 

eases,  since  this  lecture  was  first  delivered, 
has  undoubtedly  been  largely  changed  for 
the  better  by  some  skilled  specialists,  and 
some  of  my  statements  may  not  seem 
wholly  justified  now ;  but  they  are  left, 
because,  as  many  a  sufferer  knows,  the  old 
abuses  do  still  exist,  and  a  true  view  and 
enlightened  treatment  of  nerve  disease  is 
far  from  universal. 


PREFACE 

A  short  glossary  is  appended,  not  alto- 
gether on  account  of  the  difficulty  of  the 
words,  but  to  point  out  the  special  mean- 
ing the  author  wishes  to  emphasise  in  the 
text 

ALFRED  T.  SCHOFIELD,  M.D. 


6,  Harley  Street,  W, 
Easter,   1903. 


CONTENTS 


CHAPTER    I 

PAGE 

FUNCTIONAL  NERVOUS  DISORDERS       .  3 

Increase  of  Functional  Nerve  Disease — Brain 
Strain  increases,  Body  Strain  decreases — Value 
of  understanding  the  Subject — Functional  Nerve 
Disease  little  understood  —  Former  Routine 
Treatment  of  Nerves — Painful  Results  from  Mis- 
taken Diagnosis — Hysteria  is  not  "  Shamming" 
— A  Nervous  Invalid  in  a  Healthy  Family — 
Cause  of  Cruelty — Treatment  of  a  Nerve  Sufferer 
— Illustration  from  an  Actual  Case — Result  of 
seeing  the  Doctor — The  Turning-point  in  her 
Life  for  Good  or  for  Evil — Case  of  a  Nervous 
Mother — Sufferings  not  exaggerated — A  Change 
needed  —  Three  Causes  of  this  Treatment — 
Patients  are  often  to  blame  for  being  misun- 
derstood— Relief  when  understood — Imaginary 
Diseases  and  Diseases  of  the  Imagination — 
Unconscious  Mind  must  be  recognised — The 
Mind  is  one — Consciousness  is  Mental  Sight — 
The  Process  known  by  the  Product — Conscious- 
ness a  Small  Part  of  Mind — The  Mind  and  the 


CONTENTS 

Spectrum — The  Supra-conscious — We  live  con- 
sciously and  exist  unconsciously — Limits  of  the 
Conscious  Mind — Three  Systems  influenced  by 
the  Will — Rational  Action  of  the  Unconscious 
Mind  —  Reason  and  Unreason  —  Unconscious 
Mind  plays  the  Greatest  Part  in  Disease — Sir 
James  Paget  and  the  Unconscious  Mind — Mental 
Sufferings  in  Nerve  Disease — Physical  Sufferings 
— Fears  of  losing  Reason  unfounded — Neuras- 
thenics and  Neuromimetics — Dr.  Allbutt  on  Neur- 
asthenia— Hypochondria — Varieties  of  Neuras- 
thenia— Classes  of  Neurasthenics — "  Hysteria  " 
should  not  be  generally  used — Its  Proper  Use — 
But  used  here  to  mean  Neuromimesis — Organic 
and  Functional —Various  Symptoms. 


CHAPTER  II 

NEURASTHENIA     AND     NEUROMIMESIS 

DESCRIBED 33 

Normal  Nerve  Action — Six  Varieties  of  Nerve 
Structure — Transference  of  Vibrations — How  the 
Teeth  are  set  on  edge — We  think  as  we  feel, 
and  feel  as  we  think — Ideas  start  Real  Feel- 
ings— We  are  not  deceived  if  the  Ideas  are 
Conscious — Unconscious  Vibrations  or  Sensa- 
tions— Vibrations  from  Involuntary  Memories 
— Vibrations  from  Voluntary  Memories — Pain  is 
felt  in  Brain,  but  referred  to  Nerve  Origin  in 
Skin — Various  Causes  of  Pain  in  the  Little 
Finger — "Ideal"  Agony  in  a  Butcher — Seven 
Causes  for  the  Same  Pain — Undistinguishable  in 


CONTENTS 

Nerve  Disease — Pain  is  a  Mental  Impression — 
Pain  may  be  with  or  without  a  Physical  Origin 
— Unconscious  Mind  produces  Nerve  Mimicry  — 
Health  is  Unstable  Equilibrium — Power  of  the 
Intellect — Power  of  the  Emotions— Etiology 
of  Nerve  Disease  —  The  Predisposing  Cause 
is  Heredity — Exciting  Causes — Worry — Mental 
Idleness — Strain  and  Overwork— Physical  and 
Other  Causes — Nervous  People  the  Salt  of  the 
Earth — Details  of  Neurasthenia — Causes  of  Neur- 
asthenia and  Hysteria — Neurasthenia  in  Clever 
People — Classes  of  Neurasthenics — Not  due  to 
Rush  of  Life — Causes  of  Neurasthenia — Effect 
of  Alcohol — List  of  Symptoms  of  Neurasthenia 
— Some  Additions — Classification  of  Symptoms 
— Two  Stages  in  Neurasthenia — Symptoms  of 
Nerve  Irritation — Repose  a.  Sign  of  Brain  Power 
—Nervous  Debility — Neuromimesis  and  Hys- 
teria—Seat is  in  the  Brain — Pain  the  Common 
Symptom  in  Hysteria — The  Cause  being  in  the 
Brain — It  is  wrong  to  describe  "  Brain  Pain  " 
as  Nothing  at  all — Symptoms  of  True  Emotional 
Hysteria — Simulations  of  Hysteria,  or  Neuro- 
mimesis— Hysterical  and  Insane — Nervousness 
is  not  Hysteria — Hysteria  in  Ill-balanced  Brains 
— "  Suppressed  "  Gout  and  Hysteria — Dr.  Buz- 
zard on  the  Hysterical — Hysterical  Cases  not 
Fraudulent — Hysterical  Joint  Disease — Changes 
in  the  Joint — Hysterical  Spinal  Disease  and 
Paralysis  —  Cure  of  a  Case  —  Varieties  ot 
Paralysis — Paralysis  of  the  Special  Senses — 
Hysterical  Tumours— Fifty  Cases  of  Hysterical 
Tumours — Cure  of  a  Case — Spasm  of  the  Gullet 
— Hysterical  Aphonia— Other  Diseases — Sym- 
ptoms often  appear  Fraudulent — Neuromimesis 
is  more  than  Mimicry — Symptoms  of  Hysteria 
or  Neuromimesis. 


m  CONTENTS 


CHAPTER   III 

PAOI 

ON   MENTAL   THERAPEUTICS  .  ,        87 

Mental  Therapeutics  cannot  be  omitted — 
Seldom  studied  scientifically — The  Reason  why 
— A  Physician  wields  Two  Forces — Value  of 
Personality  for  Good  or  Evil  —  Manner  in 
Medicine — Value  of  Faith  and  Hope — Great 
Power  of  Unconscious  Mind — De  Fleury's 
Prophecy  —  The  Physician's  Vestibule  —  The 
Inner  Chamber  of  Mental  Therapeutics — Mental 
Curative  Qualities — The  Doctor  himself  as  a 
Medicine — Value  of  the  Family  Physician — 
Four  Varieties  of  Mental  Therapeutics — The  Vts 
Medicatrix  Natura — Is  it  a  Force? — Views  of 
Dr.  Mitchell  Bruce — The  Vis  is  the  Action  of 
the  Unconscious  Mind — Mental  Therapeutics 
act  in  All  Diseases  —  Examples  —  Anaesthesia 
without  Anaesthetics — Sickness  and  Death  from 
Mind  Action. 


CHAPTER   IV 

SELF-TREATMENT,   UNCONSCIOUS  AND 

CONSCIOUS 107 

The  Picture — Description  of  a  Clinique — 
Treatment  lightly  dismissed — Success  in  Treat- 
ment largely  due  to  the  Vis  Medicatrix  Nature 
— Dr.  Wilkinson  on  the  Vis  Medicatrix  Natures 
— Medical  Treatment  of  Minor  Importance  in 
Many  Cases — Cure  is  much  more  difficult  in 
many  Nerve  Diseases — Because  the  Vis  Medica- 
trix Aaturcz  itself  is  Inactive — First  Step  is  to 


CONTENTS 

restore  the  Vis  to  Activity — Quacks  thrive  on 
Functional  Nerve  Diseases — Why  Quacks  still 
flourish — The  Public  care  most  for  Cures — 
Mental  Therapeutics  ignored — Good  Treatment 
is  mostly  Empirical — Scientific  Teaching  is  in- 
creasing—  Cure  of  Disease  by  the  Patient — A 
Patient  can  do  much  in  an  Early  Stage — Remove 
Causes  as  far  as  possible — Patient  can  change 
the  Environment — One  Reason  for  consulting  a 
Doctor — No  Loss  of  Self-control — Patient  can 
often  treat  the  Disease — By  exerting  Mental 
Powers — Especially  in  Nerve  Diseases — Pastor 
Chiniquy  and  Typhoid  Fever  —  Chiniquy's 
Second  Cure — Cure  of  Typhoid  in  a  Nurse — 
The  Will  thrown  into  the  Scale — Many  Similar 
Cases — Auto-suggestion — Without  Hypnotism — 
Dominant  Ideas  determine  Conduct — Illustra- 
tion of  Auto-suggestion — Domestic  Treatment — 
Nerve  Disorders  seldom  unhinge  the  Mind. 


CHAPTER   V 

MEDICAL  TREATMENT  OF  FUNCTIONAL 

NERVE   DISEASES     .  .  .  .129 

Some  Conditions  of  Success  in  Functional 
Nerve  Diseases — Sympathy  in  the  Physician — 
Pain  is  a  Mental  Fact — Patience  in  the  Physician 
— Perseverance  in  the  Physician — Firmness  in 
the  Physician — Tact  in  the  Physician — Should  a 
Symptom  be  ignored  or  not  ? — The  Nature  of 
Neuromimesis — Difficulty  of  treating  these  Dis- 
eases— Importance  of  Honesty — Attention  to 
Details — Difiiculty  of  treating  Failures — Con- 
fidence* 'n  Doctor  ind  Nurse— Study  the  Patient's 


xvi  CONTENTS 

PACK 

Personality — Machine-made  "Cures"  useless — 
Methods  must  be  Adequate — Ill-health  more 
Expensive  than  any  Cure — No  "Nerve"  Nurses 
— Neurasthenic  Nurse  not  yet  produced — At 
Present  the  Nurse  is  born,  not  made — Hence  the 
Expense  of  Cures — On  Nursing  Homes — Quality 
of  Home  determines  Success  of  Treatment — 
Should  Doctors  have  their  ow^n  ? — The  Matron — 
Treatment  of  Neurasthenia  Proper — Treatment 
of  Hysteria — Value  of  Massage — Isolation — 
Suggestion — Best  given  indirectly — Hypnotism 
— Thought-turning  —  Personal  Influence  of 
Doctor — After-treatment — Cycling  and  Golf — 
Special  Treatment  in  Neurasthenia —Remove 
Cause  in  Neurasthenia — Cause  can  generally 
be  removed — Natural  Symptoms — Observe  the 
Five  Laws  of  Health — Travel  generally  Bene- 
ficial—Value of  Rest  in  Bed — Guide  to  Treat- 
ment— Pharmacy — After-cure — Which  Voyages 
are  Best — Alcohol  and  Neurasthenia — Treatment 
of  Neuromimesis — Is  it  Hysteria  only  ? — Organic 
Disease  mistaken  for  Hysteria — Mistakes  made 
on  Both  Sides — The  Vicious  Circle — Travelling 
often  a  Mistake — Re-make  Body  and  Brain — 
Hypnotism  not  very  Successful  in  Hysteria — 
Range  of  Mental  Therapeutics — Ideas  not  too 
Difficult — Cures  effected  by  Unconscious  Mind 
— Rational  and  Psychic  Treatment  —  Healthy 
Brain  exercises  Good  Influence— Electricity — 
Importance  of  Suggestion  and  of  Isolation — 
New  Brain  is  built  up — No  Details  of  Treatment 
given — Value  of  True  Christianity. 

A  SHORT  GLOSSARY        ,  •  ,  .173 

INDEX  .179 


Functional  Nervous  Disorders 


CHAPTER    I 

FUNCTIONAL   NERVOUS    DISORDERS 

THERE  can  be  no  doubt  that  disordered  increase  of 
.  .  functional 

nerves  are   everywhere   increasing.     1  nerve 

do  not  speak  here  of  organic  nerve  diseases 

of    the    brain    or    spinal     cord,    producing 

such  symptoms   as  paralyses,  spasms,  anses- 

thesias,  or  atrophies,  but  of  functional  nerve 

troubles  of  all  sorts,  whose  symptoms,  though 

perhaps    too    vague    to    classify,   yet    cause 

great  pain   to   those   who   experience   them. 

These  sufferers  abound   all   over   the   world, 

but  are  said  at  present  to  be  least  numerous 

in  Germany,  Russia,  Italy,  and  Spain,  more 

numerous  in  France,  more  so  still  in  England, 

and  most  of  all  so  in  the  United  States. 

It  is  certain  that,  with  the  increasing  evolu-  Brain 

1        •  1  •    1       •       1     •  strain 

tion  of  the  bram,  which  is  being  worked  increases, 
harder  and  harder  every  day  and  kept  at  a  decreases. 
continually  augmenting  strain  and  pressure, 

3 


4  NERVES    IN    DISORDER 

these  functional  nerve  troubles  must  increase. 
On  the  body,  on  the  other  hand,  the  strain 
is  certainly  less  ;  not  only  is  labour-saving 
machinery  everywhere  more  in  use,  but 
locomotion  is  becoming  more  mechanical,  and 
in  all  varieties  of  work  the  need  for  muscular 
effort  is  decreasing.  Indeed,  were  it  not 
for  our  athletic  sports  and  games  the  body 
might  soon  show  signs  of  deterioration.  As 
it  is,  it  exhibits  none  of  development ;  and 
its  value  consists  more  and  more  in  that  it 
is  a  necessary  agent  of  the  brain  and  mind, 
to  which,  when  in  health,  it  acts  as  a  well- 
trained  servant,  obeying  orders  and  working 
for  its  interests. 

Money  now  is  almost  exclusively  made 
at  the  expense  of  the  wear-and-tear  of  nerve, 
as  contrasted  with  muscle  tissue  ;  and  it  is 
a  matter  of  ever-increasing  economical  im- 
portance to  keep  the  money-making  machine, 
the  brain  and  mind,  at  the  highest  productive 
pitch — in  short,  in  a  state  of  perfect  health. 
Value  of         The  right  understandinsr,  therefore,  on  the 

under-  °  ° 

standing     part  of  the  laity,  of  the  way  in  which  the 

the  subject. 

altered  conditions  of  life  affect  the  nervous 
organism  is  of  the  utmost  value ;  and  a  true 
economy  consists  in  making  use  of  the  most 


FUNCTIONAL   NERVOUS   DISORDERS     5 

enlightened  and  modern  methods  of  restoring 
it  to  health  when  overstrained  or  overtaxed. 

It  is  well  known,  however,  in  spite  of  this,  Functional 

nerve 

that     while     organic     nerve     diseases     have  disease 

.  little  un- 

received  their  full  share  of  scientific  atten-  derstood. 
tion,  and  been  the  subjects  of  extended 
research  for  many  years,  much  less  time  or 
thought  has  been  expended  on  functional 
nerve  disorders.  Indeed,  it  is  only  of  late 
years,  since  this  lecture  was  first  given,  that 
they  have  been  fully  recognised  as  distinct 
diseases  in  our  country. 

France  and  America  were  the  two  pioneers 
in  diagnosis  and  treatment,  and  they  are  still 
as  far  in  advance  of  England  in  methods  and 
therapeutics  as  they  are  in  their  literature  on 
the  subject. 

Listen  for  a  moment  to  the  usual  routine  Former 
treatment  in  England  of  a  nervous  case,  trtaunent 
"  When  one  of  these  victims  to  hypochondria, 
who  are  commonly  called  -malades  imaginaires, 
has  recourse  to  medicine  for  the  relief  of 
pain,  or  some  other  disturbance,  he  is  usually 
told  it  is  of  no  importance ;  that  he  is  fanciful ; 
and  some  anodyne  is  carelessly  prescribed. 
The  patient,  who  is  really  suffering  the  pain 
he  has  suggested  to  himself,  feels  convinced 


6  NERVES    IN    DISORDER 

that  his  malady  is  not  known,  and  that 
nothing  can  be  done  for  him.  The  idea 
that  his  complaint  is  incurable  becomes 
intense  in  proportion  to  his  high  opinion  of 
the  physician's  skill  ;  and  thus  the  patient, 
who  was  suffering  from  the  painful  affection 
suggested  by  his  mind,  often  goes  away,  not 
only  unc'ired,  but  incurable."  * 

It  is  important  to  observe  that  a  disease 
due  to  the  imagination  is  not  necessarily  an 
imaginary  disease,  but  may  produce  various 
functional  and  even  organic  disturbances. 
A  wise  physician  once  said  to  me :  '*  If  a 
man  is  so  ill  as  to  say  he  is  ill  when  he 
is  not  ill,  he  must  be  very  ill  indeed."  The 
diseases  grouped  under  the  heads  of  nervous- 
ness, hysteria,  etc.,  are  real  in  origin  and 
effects,  and  formidable  in  their  nature  ;  and 
it  is  high  time  that  the  ridicule,  the  offspring 
of  ignorance,  with  which  they  have  been 
so  long  surrounded  be  entirely  done  away 
Painful  re-  with.  These  unhappy  patients  have  been 
mistaken     greatly  wrongcd,    and    often    cruelly  treated. 

diagnosis.       .  .,.,.-  .. 

A    nervous    mvalid    is    a    iar  greater  sunerer 

than  a   man   with   a   broken    leg  ;    but  with 

a   would-be   sapient   but   truly    asinine  nod, 

*  "  Animal  Magnetism  "  (Parkes). 


FUNCTIONAL   NERVOUS   DISORDERS     7 

we  are  content  to  dismiss  the  former  as  "  only 
hysterical." 

In  a  recent  medical  work  we  read  :  "  The  Hysteria  is 

not  "sham- 
sister  of  the  ward  and  the  house  physician  ming." 

settled    between    them    that    the    case    was 

hysterical,    and    the   girl   was    malingering" 

{i.3.  shamming) ;  that  is,  that  hysteria  means 

shamming.     Such  a  statement  takes  us  back 

to    the   dark    ages,   when   all   insanity    was 

possession  by  an  evil  spirit ;  for  it  certainly 

implies  that  one  with  serious    nerve  disease 

is  simply  controlled  by  some  lying  principle. 

More  sympathy  and  less  contempt  are  indeed 

felt  for  a  drunkard  than  for  a  hypochondriac. 

On  this  head  Sir  James  Paget  says,*  "  To  call 

a  patient  '  hysterical '  is  taken  by  many  people 

as  meaning  that  she  is  silly,  or  shamming,  or 

could  get  well  if  she  pleased.  .  .  .  Hysteria 

...  is  a  serious  affection,  making  life  useless 

and  unhappy,  and  not  rarely  shortening  it." 

Picture  the  misery  of  a  nervous  invalid  in  a  nervous 

invalid  in 

a  hearty  English  family,  say  of  the  bucolic  a  healthy 
order.  "  It  is  all  fancy,"  is  the  stock  phrase 
before  her  face ;  "  it  is  all  humbug,"  the  one 
behind  her  back.  This  ignorance  is  partly 
due  to  the  fact  that  the  symptoms  are  gene- 
•  Sir  James  Paget,  "  Selected  Essays,"  p.  74, 


8  NERVES    IN   DISORDER 

rally  subjective  rather  than  objective,  and 
that  observation  is  not  so  much  needed  in 
their  interpretation  as  reasoning  power. 

So  much  is  this  the  case  that  one  great 

object   in    publishing   this    monograph   is  to 

put  an  end  to  the  unconscious  cruelty   that 

Cause  of     is  SO  common  in  these  conditions.  This  cruelty 

cruelty. 

spnngs    from   several   reasons,  which  it   will 
be  well  to  consider  in  some  detail.     Let  us 
first  of  all  get  the  picture  clearly  before  us. 
Treatment       A   mother  or  a  daughter,   more   rarely  a 

of  a  nerve 

sufiferer.  father  or  a  son,  becomes  gradually  the  victim 
of  some  nervous  disorder.  Let  us  suppose  the 
case  of  a  daughter  in  some  robust  family. 
From  the  first  the  sufferer  feels  instinctively 
that  the  disease  is  something  to  be  ashamed 
of,  and  to  be  concealed  as  far  as  is  possible. 
This  is  of  course  only  feasible  up  to  a  certain 
point,  and  as  soon  as  the  girl  begins  to  be 
a  trouble  to  others  every  effort  is  made  by 
her  family  to  assure  her  "  it  is  nothing,"  that 
she  is  only  "  putting  it  on,"  that  she  could 
"  stop  it  if  she  liked,"  that  she  only  does  it 
"  to  gain  sympathy,"  and  so  on.  If  com- 
passion for  the  sufferer  is  shown  by  any 
member  of  the  family  it  is  severely  repressed 
by  the  others,  as  being  "  bad  for  her "  and 


FUNCTIONAL  NERVOUS  DISORDERS  9 
"encouraging  her."     One  who  had  been  so  lUustration 

,  ....  ,       from  an 

treated  came  to  a  physician  quite  recently,  actual  case. 
and   on   entering   his   consulting-room  burst 
into  an  agony  of  tears  and  exclaimed :  "  Oh, 
doctor !  do  you  think  I  am  shamming  ?  " 

This  girl  was  really  suffering,  I  advisedly 
say,  agonies.  The  mental  tortures,  indeed, 
are  often  so  indescribable  that  no  physical 
pain  is  to  be  compared  to  them  ;  and  over 
and  above  all  else  is  the  fear  that  the  sufferer 
should  be  dubbed  "hysterical,"  which  means 
and  can  mean  to  her  nothing  else  than 
fraudulent.  These  sufferings  are  at  times  so 
great  that  they  may  almost  drive  the  patient 
to  utter  desperation,  but  they  have  to  be 
concealed  as  far  as  is  possible  on  account 
of  the  general  ignorance  that  still  prevails  as 
to  their  real  cause. 

Eventually,  in    most   cases,  matters  reach  Result  of 

seeing  the 

such  a  pitch  that  the  self-conscious  sufferer,  doctor. 
who  feels  by  this  time  more  of  a  culprit 
than  a  patient,  has  to  see  the  doctor,  prob- 
ably the  local  medical  man.  He,  possibly 
to  some  extent  influenced  by  the  family 
request  to  confirm  their  verdict,  and  believing 
in  his  heart  that  nerves  are  mostly  "  fancy,'* 
from   a   total   absence   in   his    own    medical 


lo  NERVES    IN    DISORDER 

Studies  of  any  training  in  their  pathology, 
very  likely  tells  the  patient  that  she  is  all 
right,  her  pain,  etc.,  are  purely  imaginary,  and 
the  girl  leaves  his  presence  being  assured  in- 
directly, and  partly  convinced,  that  she  is  an 
impostor,  and  that  after  all  she  is  hysterical. 
The  doctor's  official  sanction  always  makes 
the  home  persecution — though  such  persecu- 
tion is  not  unkindly  meant,  but  intended  to 
act  as  a  cure— more  severe  ;  and  the  sufferer 
is  soon  reduced  to  apathy  and  despair. 
Obvious  physical  symptoms  by  this  time 
probably  supervene,  and  the  patient  gets  so 
much  worse  that  she  is  reluctantly  taken  to  get 
the  opinion  of  some  eminent  specialist.  This, 
practically,  is  the  turning-point  in  her  life. 
The  turn-  If  the  Selection  of  the  man  be  a  wise 
in°he°i?fe  one,  and  he  is  truly  a  serious  student  of 
or  goo  —  fyj^^.^jQj^j^j  nerve  disorders,  the  patient  has 
not  been  five  minutes  in  his  room  before 
she  feels  she  is  understood  for  the  first 
time  since  she  was  taken  ill,  it  may  be 
many  years  before.  She  begins  to  describe 
her  symptoms,  which  have  hitherto  been 
treated  with  ridicule,  timidly  and  apolo- 
getically, but  as  she  finds  she  is  gravely 
listened    to,    and    apparently    believed,    she 


FUNCTIONAL    NERVOUS   DISORDERS    ii 

grows  bolder  and  more  fluent,  and  when 
she  has  finished,  she  no  longer  expects  to 
hear  the  familiar  formula,  "  It  is  nothing,"  etc., 
but  listens  with  wrapt  interest  to  her  pros- 
pects of  cure ;  and  she  departs  willing  to 
follow  to  the  utmost  the  directions  of  the 
first  man  who  has  treated  her  sufferings 
with  respect.  Should  she,  however,  unfortu-  Or  for  evil, 
nately  fall,  as  is  still  possible,  into  the  hands 
of  a  consultant  but  little  more  modern  in 
his  views  than  the  old  family  practitioner, 
and  should  the  great  man  confirm  the  verdict  -  -^ 
that  "it  is  nothing,"  and  prescribe  that  she 
"  must  take  a  change,"  and  not  "  think  so 
much  of  herself,"  her  fate  is  practically 
sealed,  and  she  departs  not  only  unrelieved, 
but  possibly  invalided  for  life. 

Would  that  I  could  depict  the  causeless 
cruel  sufferings  and  the  chronic  invalids  that 
are  entirely  the  results  of  such  treatment ! 
Consider   the   feelings   of  a  mother  who  all  Case  of  a 

nervous 

her  life  has  given  her  strength  to  her  family,  mother, 
and  who,  when  at  last  it  begins  to  fail  and 
nerve  symptoms  set  in,  is  made  to  feel  a  fraud 
and  her  sufferings  unreal.  Or  again,  con- 
sider the  case  of  a  daughter,  the  sole  invalid 
in    an   otherwise   healthy   household,  who   is 


12 


NERVES    IN   DISORDER 


Sufferings 
not  exag- 
gerated. 


A  change 
needed. 


Three 
causes  of 
this  treat- 
ment. 


compelled  to  hide  her  nervous  dreads  and 
agonising  pains  for  fear  of  ridicule,  until 
either  the  mind  or  nervous  system  entirely 
gives  way. 

Do  not  think  for  one  moment  these  suffer- 
ings are  imaginary  or  overdrawn.  I  should 
never  depict  them,  nor  would  this  lecture 
be  published,  did  I  not  know  they  exist  in 
hundreds  of  cases  to-day  ;  indeed,  so  common 
are  they  that  there  are  few  who  read  these 
lines  who  will  not  be  able  to  recall  from 
their  own  knowledge  some  such  scene. 

It  is  truly  high  time  that  this,  the  most 
neglected  class  of  disease,  received  more 
attention  at  the  hands  of  the  profession,  and 
that  it  occupied  a  different  place  in  the  minds 
of  the  public ;  so  that  the  added  load  of 
cruel  treatment  and  misunderstanding  should 
be  taken  away  from  the  nervous  sufferer, 
and  he  or  she  be  no  longer  condemned  to 
endure  needless  pain  from  the  ignorance  of 
others.  So  much  for  the  picture  :  now  for 
the  reasons  that  alone  make  it  possible. 

It  appears  to  me  that  the  common  con- 
temptuous treatment  of  nervous  invalids  and 
their  own  deep  feeling  of  shame  at  their 
ailments  spring  from  three  distinct  causes. 


FUNCTIONAL   NERVOUS   DISORDERS    13 

In  the  first  place,  the  medical  attitude  to- 
wards these  cases  is  too  often  contemptuous 
or  incredulous,  and  these  feelings  are  reflected 
and  exaggerated  in  the  conduct  of  the  friends 
of  the  patient. 

In  the  second,  popular  opinion  has  for  so 
long  associated  the  very  word  "  hysteria " 
with  fraud  and  pretence  that  it  is  almost 
vain  to  combat  it. 

In  the  third  place,  it  may  not  be  denied 
that  the  symptoms  of  these  diseases,  spring- 
ing as  they  do  from  disordered  nerves,  do 
not  exhibit  the  grave  and  regular  sequence 
of  organic  diseases,  but  are  often  to  the  last 
extent  vague,  contradictory,  and  capricious, 
and  sometimes  apparently  foolish. 

We  may  even  go  further  than  this,  if  we  Patients 

are  often  to 

are  justly  to  hold  the  balance   of  truth   in  blame  for 

•  1  r         being 

this  matter,  and  say  that  patients  have  often  misunder- 
themselves  to  blame  to  no  small  extent  for 
their  own  capricious  conduct,  that  they  could 
well  repress,  which  leads  to  such  painful 
suspicions  of  their  good  faith.  It  may  not 
be  denied  that  the  idea  of  fraud  would  be 
much  less  common  if  patients  vigorously 
exercised  whatever  self-control  they  might 
possess   to   confine   the   signs   of   disease  to 


14  NERVES    IN   DISORDER 

those  symptoms  which  are  unavoidable. 
Doubtless  loss  of  self-control  is  itself  often 
one  of  these  signs.  Still  much  more  might 
frequently  be  done  by  patients  to  avoid 
the  appearance  of  "  putting  it  on "  that 
they  are  so  often  credited  with.  Perhaps 
this  little  hint  may  be  as  useful  to  sufferers 
as  I  hope  the  strong  remarks  I  have  already 
made  may  be  to  their  friends  and  advisers. 

All    this,    however,   does   not    throw    any 
doubts  upon  the  very  real  character  of  the 
disease  or  the  pain  attached  to  it. 
Reiiefwhen      When  once  nerve  patients  can  go  to  doctors 

under- 

stood.  with  confidence  that  their  sufferings  will  be 
understood  and  regarded  as  real  and  bond 
fide,  I  am  convinced  that,  so  far  from  this 
tending  to  establish  and  perpetuate  and  foster 
these  diseases,  it  will  largely  mitigate  their 
terrors,  greatly  shorten  their  duration,  and 
make  many  a  life  happy  that  is  at  present 
tortured  and  despairing. 

Imaginary       Up  to  fifty  years  ago  doctors  failed  to  make 

diseases  .....  ,  ,  , 

and  the    distmctions    we    have    drawn    between 

the  iraagi-   an   imaginary   disease   and  one   due    to   the 

imagination,    and    airily    dismissed    both    as 

malingering.     No    suspicion    seems   ever    to 

have    entered    their   minds    as   to    the    root 


FUNCTIONAL   NERVOUS   DISORDERS     15 

error  they  were  making,  and  the  disastrous 
consequences  for  which  they  were  surely 
responsible.  It  never  occurred  to  them  that 
an  imaginary  disease  was  a  disease  a  person 
Jiad  not  got ;  but  a  disease  due  to  the  imagina- 
tion, on  the  contrary,  was  a  disease  the  person 
had  got.  Once  this  is  fairly  understood,  and 
we  thoroughly  and  clearly  grasp  that  a 
disease  of  the  imagination  only  differs  from 
a  disease  of  the  lungs  in  being  more  obscure 
and  difficult  to  treat,  that  it  probably  causes 
more  suffering,  and  may  end  in  death,  we 
are  up  to  date,  at  any  rate,  in  this  matter. 

Archaic  survivals  (early  Victorian),  how- 
ever, everywhere  abound  amongst  doctors,  to 
whom  the  above  is  utterly  futile — a  playing 
with  expressions,  and  a  trifling  with  the 
word  "  disease."  I  do  not,  of  course,  defend 
the  term  "imagination"  or  "imaginary"  as 
scientific,  but  it  is  accurate  enough  for  our 
purpose. 

The   difficulty   is    that,  the   disease   being  Uncr  .1- 
seen  to  be  partly  of  mental  origin,  and   no  miud  must 
mind    being   known   or    recognised    by   the  nised. 
doctor  but  conscious  mind,  he  concludes  that 
the  patient  must  be  aware  of  the  mind  action 
which  is  causing  the  disease,   and    that   she 


l6  NERVES    IN   DISORDER 

is  therefore  to  some  extent  to  blame.  The 
truth,  which  we  hope  will  now  be  recognised, 
is  that  all  the  causative  changes  take  place 
in  the  unconscious  mind,  and  that  the  patient 
is  wholly  ignorant  of  anything  but  the  results 
in  the  body — the  pain  or  disease  suggested. 
This  is  the  true  solution  of  the  difficulty. 

But  we  must  try  to  explain  as  simply  as 
possible  what  we  mean  by  the  terms  "  con- 
scious "  and  "  unconscious  "  minds.  These 
expressions  are  in  themselves  misleading, 
and  give  the  idea  that  there  are  two  minds, 
and  thus  obscure  the  essential  unity.  I 
only  use  the  latter  term  here  provisionally 
until  "  mind "  is  generally  understood  to 
include  all  mind,  and  not  only,  as  now,  a 
The  mind    small    part   of  it.     The   mind   is    one :    but 

IS  one.  '■  ' 

while  one  part  is  in  constant  illumination, 
another  is  never  lighted  by  consciousness  ; 
and  between  the  two  stretches  a  tract  of 
uncertain  extent  that  is  sometimes  in  light 
and  sometimes  in  darkness — the  sub-conscious 
region. 
nessTs°'^  Consciousness,  after  all,  only  represents 
™Tt^  what  I  see  of  my  mind ;  but  surely  there 
are  many  ways  of  detecting  its  presence 
besides  sight ;    and  one  might  as  well  limit 


FUNCTIONAL   NERVOUS   DISORDERS     \^ 

the  body  to  what  one  can  see  of  it,  ignoring 
those  parts  that  are  discerned  by  touch,  as 
to  make  consciousness  the  only  proof  of  mind. 
We  can,  of  course,  see  the  image  of  our 
faces  in  a  glass,  but  we  can  just  as  clearly 
see  the  unconscious  mind  reflected  in  actions, 
and  we  have  no  more  right  to  deny  the 
existence  of  the  one  than  of  the  other.     To  The  pro- 

cess  known 

say  you  cannot  thmk  or  feel  unless  you  are  by  the 
conscious  of  the  process,  is  to  say  one  cannot 
tell  a  man  is  a  watchmaker  unless  one  actually 
sees  him  make  the  watch ;  whereas  one 
reaches  this  conclusion  by  seeing  the  watch 
itself  which  he  has  made.  In  this  case  you 
infer  the  process  when  you  see  the  product — 
the  watch.  In  like  manner,  the  results  of 
unconscious  thought  seen  in  consciousness 
prove  the  existence  of  the  unconscious  mind. 
We  must  not  only  get  rid  of  the  idea  that 
consciousness  is  mind,  but  also  that  it  is 
the  only  proof  of  mind. 

Mind,  in  fact,  may  be  conscious,  sub- 
conscious, or  unconscious.  The  second  state 
may  be  brought  into  consciousness  by  effort, 
the  last  cannot. 

Our  conscious  mind  as  compared  with  the  ne°ss^asmlii 
unconscious  mind   has   been   likened  to   the  ^^^'^^'^ 


i8  NERVES    IN   DISORDER 

visible  spectrum  of  the  sun's  rays,  as  com- 
pared with  the  invisible  part  which  stretches 
indefinitely  on  either  side.  We  know  now 
that  the  chief  part  of  heat  comes  from  the 
ultra-red  rays  that  show  no  light,  and  the  main 
part  of  the  chemical  changes  in  the  vegetable 
world  is  the  result  of  the  ultra-violet  rays 
at  the  other  end  of  the  spectrum,  which  are 
equally  invisible  to  the  eye,  and  are  only 
recognised  by  their  potent  effects. 
The  mind  Indeed,  as  these  invisible  rays  extend  in- 
spectrum.  definitely  on  both  sides  of  the  visible  spectrum, 
so  we  may  say  that  the  mind  includes  not 
only  the  visible  or  conscious  part,  and  what  we 
have  termed  the  sub-conscious,  that  lies  below 
or  at  the  red  end,  but  the  supra-conscious 
mind,  that  lies  beyond  at  the  violet  end — all 
the  regions  of  higher  soul  and  spirit  life, 
of  which  we  are  only  at  times  vaguely 
conscious,  but  which  always  exist  and  contain 
our  most  abstract  and  spiritual  faculties  as 
surely  as  the  sub-conscious  links  us  to  the 
body  on  the  other ;  both  the  supra-  and  sub- 
conscious being  parts  of  the  unconscious 
mind.  Of  course,  speaking  of  regions  and 
levels  is  merely  figurative,  the  non-extension 
of    mind   being   a   fundamental   doctrine.     I 


FUNCTIONAL  NERVOUS  DISORDERS  19 
would    include   in    the   supra-conscious   such  The  supr»- 

^        ,  .  ,  .   ,       .  ,     conscious. 

a  faculty  as  conscience,  which  is  surely 
a  half-unconscious  faculty.  Moreover,  the 
supra-conscious,  like  the  sub-conscious,  is  best 
apprehended  when  the  conscious  mind  is  not 
active.  Visions,  meditations,  prayers,  and 
even  dreams  have  been  undoubtedly  occasions 
of  the  working  of  the  mind  apart  from  the 
reason  or  consciousness. 

The  power  to  use  our  lives  through  the 
voluntary  muscular  and  nervous  systems 
appears  to  have  been  committed  to  our  reason 
and  conscious  will-power ;  while  the  power 
to  carry  on  the  processes  of  life  and  existence 
generally  is  under  the  control  of  instinct  or 
unconscious  mental  power.     We  may  be  said  We  live 

conscioxisly 

to  live  consciously  and  to  exist  unconsciously,  and  exist 
The  two  powers  are  variously  exercised ;  for  sdousiy. 
while  in  health  the  conscious  mind  often  acts 
to   the   detriment   of  the   body,  the   uncon- 
scious never  does,  save  when  it  is  diseased. 
The  direct  limits  of  the  conscious  mind  and 
will   are    fairly    defined,   and    are    generally  Limits  of 
pretty   constant,  though   in   some   few   indi-  scious 
viduals  they  extend  much  further  than  in  the  ™'"  * 
majority ;    but   under   no   circumstances  can 
the  will  produce  any  direct  organic  change  in 


NERVES    IN   DISORDER 


Three 
systems  in- 
fluenced by 
the  will. 


Rational 
action  of 
the  uncon- 
scious 
mind. 


Reason 

and 

unreason. 


the  body.  With  heart  and  circulation  the 
direct  influence  is  very  small.  By  conscious 
effort  in  some  people  the  heart  can  be 
slowed  ;  and  I  believe  there  have  been 
instances  where  it  could  be  arrested.  We 
cannot  hold  our  breath  indefinitely,  but  short 
of  this  can  vary  respiration  to  any  extent  by 
our  will. 

The  respiratory  (amongst  the  vegetative 
systems)  and  the  nervous  and  muscular 
systems  are  the  three  over  which  the  will 
has  a  large  range  of  power,  while  over  the 
rest  its  control  is  very  limited. 

Wherever  the  boundaries  of  the  conscious 
are  reached,  there  the  powers  of  the  un- 
conscious mind  begin,  and  its  actions,  though 
only  styled  instinctive,  may  be  truly  said 
to  be  on  the  whole  far  more  rational  and 
beneficial  than  those  inspired  by  what  is 
always  assumed  to  be  reason,  but  which 
just  as  often  is  unreason,  and,  indeed,  be- 
comes at  times  a  positive  power  for  evil 
over  the  body — a  disaster  which  rarely 
happens  in  the  case  of  the  unconscious  mind. 
We  think  we  live  entirely  as  reasonable 
beings,  but  it  is  very  seldom  that  we  do, 
and  none  of  us   could   exist  for  a  day  were 


FUNCTIONAL   NERVOUS   DISORDERS    21 

we   not  guarded   and  guided   incessantly  by 

a  never-erring  instinct 

A  great  part  of  our  mental  actions  being  Uncon- 
scious mind 
beneath  the  level  of  consciousness,  the  result  plays  the 

is  that  the  mind  may  play  a  large  part  in  pan  in 
disease  without  our  being  in  the  least  aware 
of  it,  or  having  the  power  to  prevent  it. 
No  physician  who  limits  mind  to  conscious- 
ness can  in  my  opinion  rightly  understand 
the  true  cause  of  many  functional  nerve 
diseases ;  and  it  is  to  this  disastrous  limiting 
of  our  mental  processes  to  our  knowledge 
of  them  that  so  much  of  the  needless  pain 
we  have  spoken  of  is  really  due. 

A  notable  illustration  of  this  may  be  seen  Sir  James 

Paget  and 

in  Sir  James  Paget's  essay  on  "  Nervous  the  uncon- 
Mimicry,"  *  where  he  evidently  feels  that  mind. 
nervous  mimicry  is  mental  in  its  origin, 
and  yet,  limiting,  as  was  common,  mind  to 
consciousness,  he  is  unable  wholly  to  accept 
this  hypothesis  in  all  cases.  Some  {i.e.  those 
that  can  somehow  be  connected  with  con- 
sciousness) he  of  course  recognises  as  of 
mental  causation,  while  others  (in  children, 
or  at  any  rate  having  nothing  to  do  with 
consciousness)  he  does  not.  He  also  points 
*  Sir  James  Paget,  "  Selected  Essays,"  pp.  82,  83. 


NERVES    IN    DISORDER 


Mental 
sufferings 
in  nerve 
disease. 


out  that  he  has  always  failed  himself  to 
produce  any  mimicry  of  disease  by  any 
direction  of  his  mind  (showing  again  that  it 
is  the  conscious  mind  that  he  alone  recog- 
nises). He  gives  this  as  a  proof  that  all 
cannot  do  so ;  whereas  the  truth  is  that 
none  can  produce  nervous  viiniicry  by  con- 
scious effort,  and  if  they  did  it  would  be 
fraud,  and  not  neuromimesis. 

Apart,  however,  from  any  suffering  from 
errors  in  diagnosis,  which  is  preventable,  there 
is  in  functional  nerve  disease  itself  always 
great  and  unavoidable  misery.  The  disease 
may  begin  insidiously,  and  it  is  only  perhaps 
after  some  interval  of  time  that  the  patient 
realises  that  she  is  different  from  others 
physically,  or,  as  it  often  appears  to  her, 
mentally  ;  for  all  sufferings  can  be  grouped 
as  belonging  to  the  body  or  the  mind. 
Mental  suffering  may  "be  acute  without  any 
disorder  of  the  mind  existing.  Indeed,  where 
the  mind  is  partly  or  wholly  unhinged,  suffer- 
ing is  often  wholly  absent. 

In  nerve  disease  the  mental  sufferings  are 
really  mostly  due  to  the  fact  that  the  con- 
scious mind  is,  as  a  whole,  sound,  and  hence 
can  feel  intensely  the  disordered  state  of  thf' 


FUNCTIONAL    NERVOUS   DISORDERS    23 

nervous  system.  This  may  show  itself  in 
dreads,  fancies,  fixed  ideas,  morbid  thoughts, 
suspicions ;  or  perhaps  losses  of  memory,  of 
association,  of  vigour,  of  keenness  of  intellect, 
of  quickness  of  feeling,  of  moral  sense,  or  the 
faculties  may  be  exaggerated  in  many  ways  ; 
but  through  it  all  the  mind,  as  a  whole,  is 
sound,  and  generally  recognises  the  morbid 
state  of  the  nerves  when  explained,  and  longs 
to  have  it  removed  ;  though  in  some  cases 
the  true  condition  is  not  perceived. 

The    bodily    sufferings    may    range    from  Physical 

sufferings. 

mere  weakness  to  the  agonies  of  almost 
every  known  disease,  which  can  all  be 
reproduced  by  the  unconscious  mind  with 
perfect  fidelity,  even  against  the  conscious 
will  or  wish  of  the  person. 

It  will  be  readily  understood,  without 
entering  into  details  (which  may  be  left  to 
the  next  chapter),  what  a  range  of  suffering 
is  comprised  here  in  mind  and  in  body  ;  in 
fact,  it  may  be  said  once  for  all  that  in  no 
other  disease,  not  even  in  cancer  itself,  is  such 
an  extended  range  of  acute  and  often  intoler- 
able pain  possible  as  in  functional  nerve 
disease ;  and  this  class  undoubtedly  contains 
some  of  the  greatest  sufferers  on  earth.     Not 


24  NERVES    IN    DISORDER 

Fears  of     Q^iy  ^^qq^  j|-  consist  in  the  causes  we  have 

losing  -' 

'eason        enumerated,  but  superadded  is  often  another, 

anfoundea 

which  inflicts  intolerable  agonies,  and  that  is 
the  apprehension  of  the  loss  of  the  mind — 
though  fortunately  this  but  very  seldom 
comes  to  pass. 

It  is  obvious  that  such  fear  must  frequently 
exist  where  so  much  mental  suffering  is 
found,  and  it  is  of  great  comfort  that  it  can 
be  here  emphatically  stated  that  the  dread 
is  far  greater  than  the  danger,  and  that 
comparatively  very  few  nerve  sufferers  ever 
lose  their  reason. 
Neuras-  Looking  at  the   classes  of  nerve  diseases 

themes  and  ° 

neuro-        of  functional  character,  we  find  they  fall  into 

mimetics. 

two  great  groups — the  Neurasthe7iics,  or 
sufferers  from  nerve  weakness  of  various  kinds, 
and  the  Neuroniimetics,  or  sufferers  from 
nerve  disorders,  or  unconscious  mind  disorders 
of  an  "  hysterical  "  nature. 

The  first  class  of  neurasthenics  have,  as  we 

have  pointed  out,  only  recently  been  treated 

with     respect    as    real    sufferers,     and    yet 

Dr.  Aiibutt "  neurasthenia,"     says     Allbutt     boldly,     "  is 

on  neuras- 
thenia,       neither   a    sham    nor    a  figment.       It   is    no 

mere  hotchpotch  into  which  odds  and  ends 

of  nerve  troubles  are  thrust" 


FUNCTIONAL   NERVOUS   DISORDERS    25 

The  word  "  neurasthenia "  simply  means 
nerve  weakness.  The  term  itself  was  un- 
known in  England  before  1886,  though  used 
earlier  in  Amerioa  and  Germany. 

Neurasthenia  used  to  be  called  hypochon-  Hypochon- 
driasis, being  of  course  put  down  at  first 
to  that  long-suffering  organ,  the  liver.  The 
term  "  hypochondria "  is  now  reserved  for 
a  fixed  delusive  idea  of  some  particular 
disease  or  local  suffering.  Herman  defines 
it  as  "the  belief  without  cause  of  serious 
bodily  disease."  This  brings  it  very  near 
hysteria,  which  is  largely  the  nervous  mimicry 
of  disease. 

Neurasthenia  and  neuromimesis,  or  hysteria, 
may  of  course  coexist ;  but  the  former  is  de- 
cidedly more  common  in  men  than  the  latter. 

There  are  many  varieties  of  neurasthenia.  Varieties  of 
When  the  chief  trouble  is  in  the  head,  we  thenia." 
speak  of  cerebral  neurasthenia ;  when  it  is 
in  the  spine,  of  spinal  neurasthenia.  In 
some  the  abdominal  viscera  are  affected, 
and  this  is  visceral  neurasthenia.  In  others 
a  very  common  form  is  sexual  neurasthenia, 
and  these  are  often  considered  the  most  in- 
curable, and  are  certainly  the  most  trouble- 
some to  deal  with. 


26  NERVES    IN    DISORDER 

Classes  of        yj^g  classcs  of  ncurasthenics  vary  as  much 

neuras-  ■' 

thenics.  as  the  varieties  of  neurasthenia.  There  are 
three  classes  clinically  constantly  observed — 
the  patients  who  look  perfectly  well  and 
are  cheerful,  the  nervously  ill  and  wretched, 
and  the  mentally  ill  and  gloomy.  The 
first  class  are  well  nourished,  plump,  rest- 
less, and  talk  without  ceasing  ;  but  the 
other  two  are  downcast,  and  the  latter 
especially  will  hardly  speak.  Idlers  are 
frequently  neuropaths,  and  need  equal 
treatment  for  body  and  mind.  This  is 
generally  successful  if  these  idlers  are 
men    of  capacity. 

But  the  subjects  of  functional  nerve  disease 
are  by  no  means  always  drawn  from  the 
same  class,  either  mental,  moral,  or  physical. 
We  find  sufferers  amongst  the  greatest  and 
the  least,  the  noblest  and  the  basest,  the 
strongest  and  the  weakest,  amongst  men 
and  women.  The  same  elements,  after  all, 
exist  in  great  men  and  neuropaths ;  only 
in  the  former  there  is  power  to  subordinate 
the  means  to  the  end,  and  to  keep  the  idea 
noble  and  the  habits  excellent.  Nervous- 
ness, after  all,  is  an  excess  of  self-conscious- 
ness of  a  normal  quality. 


FUNCTIONAL   NERVOUS    DISORDERS     27 

Turning  to  neuromimesis,  which  simply 
means  nerve-mimicry,  it  will  be  observed 
we  do    not  use   the  word  "  hysteria  "  at  all.  "Hysteria 

should  not. 

We    have    already    pointed    out   that   from  be  gene- 
maltreatment      and     misunderstanding     this 
word    has     become    most    undeservedly    an 
actual   reproach ;  so   that   to   call    a    person 
"  hysterical "  is  to  give  him  a  bad  name. 

For  this  and  other  reasons  the  word 
"  hysteria "  has  become  so  unpleasant  and 
misleading  that  it  should  be  used  as  seldom 
as  possible,  and  to  this  end  I  think  the 
word  might  be  severely  restricted  to  those  I's  proper 
cases  described  under  this  head  by  the  most 
modern  authorities,  which  are  mainly  char- 
acterised by  alterations  in  the  field  of  vision, 
by  sensations  in  various  parts  of  the  body, 
and  by  convulsive  attacks.  Neurasthenia 
and  hypochondria,  at  any  rate,  should  never 
be  confounded  with  it.  There  may  be  and 
always  are  borderland  cases  ;  but  we  should 
be  clear  that  neurasthenia  is  not,  and  should 
not  be  called,  hysteria. 

But  preaching  is  one  thing  and  practising  But  used 
quite   another,  and  for  the  present  m  these  mean  neu- 

,  •  1       1         r  romimesis. 

pages  one  must  be  content  with  the  former 
without  the  latter ;    for  it  is   clinically  con- 


28  NERVES   IN   DISORDER 

venient,  till  the  difference  is  generally  re- 
cognised, to  speak  of  neuromimesis  and 
hysteria  together,  both  being  diseases  of  the 
unconscious  mind,  and  content  ourselves 
here  with  raising  a  protest  and  making 
suggestions  for  the  future.  As  a  matter  of 
fact,  the  remarks  I  shall  make  on  hysteria 
will  apply  far  more  to  neuromimesis,  or 
the  nervous  mimicry  of  organic  disease, 
than  to  the  true  form  of  narrowed  sensations 
and  convulsive  seizures. 

We  may  repeat  that  in  all  that  we  have 
said,  and  shall  say,  we  refer  to  functional 
nerve  diseases  only.  It  may  be  that  some 
of  my  readers  may  not  understand  the  full 
significance  of  this  term. 
Organic  It  is  used  in   contradistinction  to  organic 

functionaL  nerve  diseases,  which  form,  as  we  have  pointed 
out,  a  large  and  well-explored  group,  resting 
one  and  all  upon  some  gross  and  ascertained 
organic  change  in  some  of  the  nervous 
structures  of  the  body.  If  it  is  in  the  nerves 
ending  in  the  body  it  is  peripheral ;  if  it  is 
in  the  structures  of  the  cord  it  is  spinal;  if 
in  the  brain,  cerebral.  These  organic  diseases 
are  less  characterised  by  pain  (of  mind  or 
body)   and   more   by  other   changes  than  is 


FUNCTIONAL  NERVOUS  DISORDERS  29 
the   case  in   functional   nerve  diseases.     The  Various 

.     symptoms. 

symptoms  are  commonly  those  of  paralysis 
in  various  forms  and  parts,  or  of  imperfec- 
tion of  muscular  actions  and  of  sensations ; 
but  though  as  a  rule  the  symptoms  are 
more  severe,  they  cause  less  distress  to  the 
sufferer,  and  are  generally  treated  with  much 
more  interest  and  respect  by  the  doctor 
than  those  of  functional  nerve  disease. 

These  few  remarks  will  serve  to  introduce 
the  subject  to  our  readers,  and  we  trust  also 
will  show  its  importance  both  to  the  patient 
and  the  doctor. 

We  are  firmly  convinced  that,  when  the 
true  causes  of  functional  nerve  diseases  are 
understood,  the  sufferings  connected  with 
them  will  be  lessened,  and  the  cures  greatly 
multiplied. 


Neurasthenia  and  Neuromimesis 
Described 


CHAPTER    II 

NEURASTHENIA    AND    NEUROMIMESIS 
DESCRIBED 

BEFORE  entering  on   details   of  nerves  Normal 
.  .  nerve 

"  in  disorder,"  it   will    greatly  help  us  action. 

if  we  briefly  consider  in   a  simple  way  the 

normal    manner    of    action   of    nerves    "in 

order." 

Nervous   structures  in   the  brain  may  be  Six  varie- 
ties of  nerve 
divided  into  six  varieties: — (i)  The  organs  ^T/stmcttire. 

special  sense,  including  the  nerves  of  hearing, 

sight,   touch,    taste,    and    smell ;    and,    with 

regard   to   these,  let   us   observe    that   mere 

mechanical   irritation   of  them   will   produce 

their  phenomena.     A  blow  on  the  eye  in  the 

dark   will   produce  the   appearance  of  light, 

because  the  optic  nerve  is  irritated  ;  not,  it 

is  true,  by  waves  of  light  in  the  retina,  but 

by  concussion.     Sounds  of  all  sorts  are  heard 

when  there  are  none,  if  the  nerve  of  hearing 

33  3 


34  NERVES    IN   DISORDER 

be  irritated  by  disease,  instead  of,  as  usually, 
by  the  waves  of  sound.     Smells  and   tastes 
are  also  clearly  perceived  and  described  when 
none  actually  exist.     The  important  bearing 
of    this    on    nervous    disease    will    soon   be 
apparent.     (2)  A'Cfves  of  sensation,  that  bring 
intelligence  to  the  brain   from  every  part  of 
the  body.     (3)  Terminal  Jiei'oe  centres,  in  the 
cortex   or  surface  of  the   brain,   that  receive 
and  transmit  all  nerve  messages,  being  under 
control    of  the   will.      (4)  Nerves  of  ^notion, 
that   carry   nerve   force    from    the    brain    to 
every  muscle.      (5)  Autoviatic  nerve   centres, 
that   carry   out   vital    processes    apart    from 
any  exercise  of  will,  such  as  the  beating  of 
the  heart,  the  processes  "of  respiration,  diges- 
tion,   etc.       (6)  Ideal  tiente   centres,    the   seat 
of   thoughts    only,    the    most    actively    used 
and,  perhaps,  least  understood  of  any. 
Trans-  'W\^  nervc  molecule  is  said  to  contain  one 

fercnce  of 

\'ibrauons  rhousand  or  more  atoms,  and  all  nerve  action 
is  believed  to  be  by  vibration  of  these  atoms, 
all  force  being  ultimately  caused  by  similar 
means.  If  I  tJiink,  certain  vibrations  are 
believed  to  take  place  in  my  ideal  nerve 
cells  ;  if  I  feel  or  act,  in  my  sensory  or  motor 
nerve  cells.     Thought  and  action,  which  to  us 


NEURASTHENIA  AND  NEUROMIMESIS     35 

appear  so  widely  different,  would  probably, 
had  we  strong  enough  powers  to  see  them,  be 
perceived  to  be  changes  similar  to  each  other, 
but  occurring  in  different  centres.  Both  are 
cell  actions,  and  are  nearly  allied,  the  cells 
often  being  probably  side  by  side  or  very 
closely  connected  ;  and  thus  an  action  com- 
mencing in  one  nerve  centre  may  readily 
be  transferred  to  another.  An  instance  will 
suffice. 

The   fact   of  the  teeth  being  set  on   edge  How  the 

°  ,  teeth  are 

by  the  scraping  of  a  slate  pencil  on  a  slate  set  on  edge 
is  too  well  known  to  need  description.  But 
what  is  the  cause  ?  We  hear  the  scrape,  and 
as  the  unpleasant  sound  is  composed  of  air- 
waves of  irregular  lengths,  it  jars  the  auditory 
nerve,  and  communicates  special  vibrations 
to  its  particles.  It  happens  that  in  part  of 
its  course  this  nerve  lies  alongside  another, 
that  joins  farther  on  one  coming  from  the 
teeth  and  tongue.  The  jarring  is  communi- 
cated from  the  auditory  nerve  to  the  dental 
nerve  by  contiguity,  and  the  brain  receives 
the  sensation  of  the  teeth  being  set  on  edge 
shortly  after  the  disagreeable  sound  is  heard. 
This  is  an  illustration  of  the  transference  of 
feeling  from  one  nerve  of  sensation  to  another. 


36  NERVES    IN   DISORDER 

Let  us  consider  transference  of  vibration  *  to 

sensory  and  motor  centres  from  ideal  centres. 

We  think        It  has  been  well  said,  "We  think  as  we 

as  we  feel, 

and  feel  as  feel  or  think  we  feel,  and  we  feel  as  we  think. 

we  think. 

If  we  feel  a  pain,  we  think  we  are  ill ;  and 
if  we  think  we  are  ill,  we  feel  ill."  If  my 
ideal  centre  vibrates  with  the  thought  of 
crossing  the  Channel  in  rough  weather,  and 
pictures  the  nausea  that  would  then  be  felt, 
the  vibrations  are  transmitted  to  the  terminal 
centres  of  the  sensory  nerves  running  from 
the  stomach,  and  I  actually  feel  sick  from 
communication  of  the  idea  with  a  sensory 
centre  ;  and  possibly,  if  of  a  highly  nervous 
organisation,  may  actually  be  sick  from 
transference  to  a  motor  centre. 
Ideas  start  Real  feelings  and  real  acts  can  be  started 
feelings.  in  entirely  ideal  Centres .  If  we //z/;'?;^  intensely 
of  any  part  of  the  body  long  enough,  we  feel 
sensations  in  that  part.  If  we  think  of  a 
good  dinner  the  mouth  waters.      We  shiver 

*  The  word  "  vibration,"  applied  all  through  here 
to  nerves  and  nerve  centres,  is  popular  rather  than 
scientific,  for  such  vibr  itions  cannot  be  demonstrated. 
We  believe,  however,  that  every  mental  action  has 
some  physical  counterpart  in  the  nerve  structures,  to 
which  we  give  the  name  of  "vibration,"  as  it  probably 
consists  in  some  movement  of  the  nerve  atoms. 


NEURASTHENIA  AND  NEUROMIMESIS     37 

whether  we  only  think  of  cold  or  actually 
feel  cold.  The  sensation  of  pain  can  be  pro- 
duced as  really  and  vividly  by  thoughts  or 
ideas  alone  as  light  in  the  eye  by  striking  it 
In  short,  every  sensation  of  the  body  ordinarily 
produced  from  without  can  also  be  produced 
from  within.  It  is  thus  that  the  ideo-sensory 
and  ideo-motor  actions  are  produced. 

These  ideal  vibrations,  acting  on  motor  and  We  are  not 

.        deceived 

Other  centres,  are  quite  different  from  the  action  if  the 

_  1  1         1  •  •  1  /-  ideas  are 

of  a  motor  centre  by  the  direct  impulse  of  conscious. 
the  will  ;  the  action  being  in  the  latter  'case 
voluntary  and  in  the  former  involuntary.  So 
far,  observe,  we  have  only  spoken  of  ideas  of 
which  we  are  conscious,  so  that,  although  the 
modes  of  exciting  these  motor  and  sensory 
centres  are  abnormal,  we  know  them  to  be  so, 
and  hence  are  not  deceived,  and  do  not  deceive 
others,  into  believing  them  to  be  natural. 

Thus,  when  our  teeth  are  set  on  edge  from 
sounds  we  do  not  go  to  a  dentist ;  if  we 
are  sick  from  ideas  we  do  not  think  we  are 
dyspeptic  ;  if  we  hear  noises  in  the  ear  we 
do  not  look  for  them  externally  ;  if  we  shiver 
from  thinking  of  cold  we  do  not  put  on  more 
clothing.  But  now  let  us  go  one  step  further 
into   the   region  of  unconscious    cerebration 


38  NERVES   IN   DISORDER 

and  of  memories  and  habits,  and  the  theory 
I  wish  to  present  as  to  the  internal  causation 
of  these  nerve  troubles  so  often  grouped  under 
the  word  "  hysteria  "  will  be  made  plain. 
•cT"^-  The  brain  not  only  acts  by  the  will  and 
brauons  or  \yy   jdeas   of  which  we  are  conscious,  but  is 

sensations.      "^ 

continuously  vibrating  with  ideas,  memories, 
and  trains  of  thought  of  which  we  are  un- 
conscious. It  is  so  even  with  regard  to 
common  sensation.  If  you  concentrate  your 
attention  on  any  part  of  your  body,  you 
become  aware  of  sensations  in  it  that  escaped 
your  attention  before,  but  were  equally  there 
then.  If  with  a  feather  I  lightly  tickle  the 
back  of  your  neck,  and  at  the  time  you  are 
engaged  in  very  earnest  conversation,  the 
vibration  aroused  in  the  brain  sensory  centre 
is  unnoticed  by  you  ;  and  yet  if  I  call  your 
attention  to  the  fact  it  is  noticed  at  once. 
By  increasing  the  stimulus  I  can  make  the 
waves  of  vibration  set  in  action  motor  centres  : 
involuntary  ones,  such  as  cause  a  shaking 
or  shuddering  of  the  neck ;  or  voluntary, 
such  as  turning  the  head  round  or  moving 
away.  If  you  are  asleep  I  may  tickle  your 
foot  so  that  you  draw  the  leg  away  and  you 
wake   up.     In  this   case  you    are    probably 


NEURASTHENIA  AND  NEUROMIMESIS     39 

conscious  of  moving  your  leg;  but  the 
stimulus  that  made  you  do  it  was  too  slight 
to  reach  your  consciousness.  We  may  thus 
be  conscious  of  a  transferred  vibration  leading 
to  action  or  sensation,  and  yet  be  ignorant 
of  the  cause    that  set  it  going.     Memories  Vibrations 

from 

again   will   involuntarily,  and  it  may  be  un-  involuntary 

consciously,  arouse  both  feelings  and  actions. 

I  may  have  smelt  the  strong  scent  of  some 

flower  when  some  critical  event  took  place — 

a  proposal  of  marriage,  or  some  sudden  news  ; 

henceforth,  whenever  the  topic  is  touched  on, 

the  very  scent  or  vibrations  of  the  nerve  of 

smell  that  represent  it  are  exactly  reproduced. 

A  certain  field  always  recalls  a  certain  song 

we  used  to  sing  as  we  crossed  it  on  our  way 

to  school.     Thoughts  of  old  Anglo-Indians 

set  the  vibrations  of  Eastern  sights  and  sounds 

in  action  again  in  the  old  centres.     Observe, 

in    all  these   cases    we   are   not  considering 

vibrations  deliberately  set  up  by  the  will  in  Vibrations 

from 

an  unusual  way.     You  can,  of  course,  pro-  voluntary 

1  1  •<■  1.1/-  ,-1,1         memories. 

duce  these  if  you  think  of  a  green  field  when 
in  a  drawing-room,  until  you  set  in  vibration 
the  centre  of  sight  and  see  the  green  grass; 
or  the  centre  of  hearing,  and  hear  the  lowing 
of  the  cattle  or  the  hum  of  the  insects.     This 


40  NERVES    IN   DISORDER 

is  much  easier  if  there  are  no  distracting 
sounds,  and  if  you  close  your  eyes  ;  and  still 
more  so  if  there  are  some  insects  actually 
humming  in  the  room.  But  the  memories 
we  speak  of  are  wholly  involuntary  ones. 
Pain  IS  felt       Lg|-  yg  jjq^  g^j^  yp  Q^j-  fesults,  taking  a 

m  brain,  *  '  ° 

but  referred  definite  case,  say,  of  a  pain  in  the  little  finger. 

to  nerve  .... 

origin  in      This  pain  is  felt  in  the  little  finger,  we  say, 

skin. 

though  we  really  know  that  the  only  seat  of 
any  sensation  is  in  the  brain.  It  is  there,  at 
the  central  termination  of  the  ulnar  nerve 
(that  we  call  the  funny-bone),  which  leads 
from  the  little  finger,  that  all  the  vibrations 
take  place  of  which  the  mind  becomes  con- 
scious and  calls  pain.  Whenever  these  vibra- 
tions take  place  in  the  nerve  centre  in  the  brain 
connected  with  the  little  finger,  the  mind 
always  refers  the  sensation  to  the  commence- 
ment of  the  nerve  in  the  little  finger,  whatever 
may  be  the  real  origin  of  this  pain. 

In  the  same  way,  if  in  your  house  the 
hall-door  bell  rings  you  say  there  is  some 
one  at  the  hall  door ;  if  the  drawing-room 
bell,  there  is  some  one  there :  and  yet  such 
may  not  be  the  case.  I  may  have  pulled  the 
door-bell  wire  inside  the  hall,  or  as  I  passed 
down  the  kitchen  stairs  ;  or  a  rat  may  have 


NEURASTHENIA  AND  NEUROMIMESIS     41 

moved  it,  or  I  may  have  struck  the  bell 
itself  and  made  it  ring,  or  a  shock  of  earth- 
quake may  have  shaken  it,  or  a  strong  gust 
of  wind ;  and  yet,  although  these  causes  are 
so  various,  you,  in  the  kitchen,  always  say, 
"  There  is  some  one  at  the  front  door." 

It  is  so  in  the  body,     (i)  The  little  finger  Various 

.,,         ,  .  ..         ii-i/-  causes  of 

IS  pricked — there  is  pain  in  the  little  finger,  pain  in  the 
(2)  The  ulnar  nerve  itself  is  pressed  on  "  ^  "^^'^' 
somewhere  in  its  course,  perhaps  at  the 
elbow — there  is  pain  in  the  little  finger. 
The  hand  may  be  cut  off,  and  still  if  the 
nerve  be  irritated  in  the  stump  by  pressure 
the  man  feels  the  pain  in  his  imaginary  little 
finger  as  truly  and  vividly  as  if  it  were  still 
actually  there.  (3)  Or  again,  there  may 
be  a  tumour  pressing  in  the  brain  on  the 
centre  of  the  ulnar  nerve,  and  the  most 
acute  pain  is  felt  in  the  little  finger.  All 
these  instances  are  from  direct  irritation  of 
the  nerve  in  some  part  of  its  course.  But 
as  we  have  seen,  we  may  go  much  further. 
The  hall-door  wire  may  have  got  caught 
with  the  drawing-room  one,  so  that  when 
the  latter  is  pulled  it  is  the  hall-door  bell 
that  rings  ;  the  vibration  is  thus  transferred. 
So  in  the  brain.     (4)    I  may,   for   example. 


42  NERVES    IN   DISORDER 

set  to  work  to  think  of  my  little  finger,  and 
so  start  sensations  in  it  which  if  not  actual 
pain  are  still  sensations.  But  if  I  have  the 
idea  it  is  injured,  though  it  may  not  be,  I 
may  feel  the  pain  acutely  from  an  idea 
"Ideal"     alone.       A     butcher,     pale,     pulseless,     and 

agony  in  a  *■ 

butcher,  suffering  acute  agony,  as  he  said,  in  his 
arm,  was  brought  the  other  day  into  a 
chemist's  shop.  His  cries  were  dreadful,  for 
he  had  slipped  in  hooking  a  heavy  piece  of 
beef,  and  was  suspended  by  his  arm  on  the 
sharp  hook ;  and  yet  when  the  arm  was 
exposed  it  was  uninjured,  the  hook  having 
only  caught  in  the  sleeve. 

(5)  But  again,  the  pain  may  have  been 
originally  caused  by  a  gathering  in  the  little 
finger,  and  afterwards  kept  up,  long  after 
the  gathering  was  gone,  by  the  thought  of  it 
in  the  ideal  centre.  (6)  Association  may 
produce  pain,  as  seeing  others  with  crushed 
little  fingers.  Or  (7)  memories,  conscious  or 
unconscious,  of  previously  crushed  little  fin- 
gers, may  also  start  and  keep  up  this  pain. 

Seven  Observe,  then,  the  varied  causes  with  the 

causes  for 

the  same     same    effect.      The   little    finger   is    in    pain 

pain. 

(i)  from  an  injury,  (2)  from  pressure  on  the 
nerve,  (3)  from  pressure   on  a  nerve  centre 


NEURASTHENIA  AND  NEUROMIMESIS     43 

in  the  brain,  (4)  from  transference  by  idea, 
(5)  from  habit  of  thought,  (6)  from  association, 
(7)  from  memory.  Only,  in  conclusion,  we 
may  add  that  while  in  health  it  is  generally 
easy  to  discriminate  between  pain  in  the 
little  finger  caused  by  injury  to  the  little 
finger  and  that  set  up  in  other  ways,  in 
nerve  disease  it  is  not.     Nay,  it  is  sometimes  Undistin- 

gfuishable 

impossible  not  only  to  the  sufferer,  but   to  in  nerve 
the    doctor    who    attends    him,    and    hence 
mistakes  in  treatment  are  easily  made. 

From  all  this  we  now  see  clearly  : — 

Fi'rsL   that   pain   in  all  cases  is  a   mental  Pain  is  a 

'  -^  mental  mi 

impression  arising  from   certain   changes   or  pression. 
vibrations  in  the  cerebral  ner\'e  centres,  and 
so  entering  consciousness. 

Second,  that  in  perfect  health  of  the  whole 
mind  we  are  generally  able  correctly  to  find 
the  true  cause  of  the  pain  and  the  origin  of 
the  vibrations  that  produce  it.  We  find,  for 
instance,  some  part  of  the  body  diseased 
or  injured  in  which  we  "  feel  the  pain." 
Very  seldom,  indeed,  in  perfect  mental 
liealth  does  a  mere  impression  produce  acute 
physical  pain.  When  the  unconscious  mind  ^^'".'?^y 
is  diseased,  as  in  hysteria,  it  is  far  otherwise,  without  a 

\  _  physical 

Here    the    suggestions    unconsciously    made  origin. 


44  NERVES    IN   DISORDER 

vibrate  in  the  ideal  centres  so  strongly  that 
pain  is  produced  and  felt  equal  in  intensity  in 
every  way  to  that  produced  by  local  lesions 
in  the  body. 

In  all  functional  nerve  diseases  the  brain 
centres  are  greatly  weakened,  and  hence 
vibrate  much  more  readily  and  intensely  to 
changes  in  neighbouring  ideal  centres  than 
they  do  in  health.  Pain  is  felt  more  intensely. 
It  is  felt  from  slight  physical  causes,  and 
is  felt  more  readily  from  purely  ideal  causes, 
but  it  is  not  referred  directly  to  any  supposed 
Uncon-       disease    save     in     neuromimesis    or    nerve- 

scious  mind 

produces  mimicry ;  and  here  the  thought  or  fear  of 
mimicry,  the  discase  has,  through  the  marvellous  force 
of  the  unconscious  mind,  not  only  power  to 
produce  characteristic  pain,  but  to  start  the 
whole  chain  of  symptoms  generally  associated 
with  the  disease,  and  which  in  it  cause  the 
Health  is     pain.     We  must  remember  that  health  itself 

unstable 

equiii-  is  but  a  Condition  of  unstable  equilibrium,  and 
a  very  little  push  upsets  the  balance,  and  pro- 
duces dis-ease — health  being,  of  course,  ease. 

Power  oi         In  neuromimesis  the  intellect  can  influence 

the  intel-  •      t  ,  ,  ,  , 

lect.  and     produce    indirectly    through    the     un- 

conscious mind  hyperaesthesia,  anaesthesia, 
paraesthesia,  dysaesthesia,  and  all  varieties  of 


NEURASTHENIA  AND  NEUROMIMESIS     45 

special  sensation.  The  intellect  can  contract 
or  relax  muscles,  and  cause  regular,  irregular, 
and  excessive  movements,  spasms,  and  con- 
vulsions. It  can  also  produce  loss  of 
muscular  power  and  paralysis.  Intellect  can 
in  the  same  way  influence  the  involuntary 
muscles  of  the  heart,  lungs,  blood-vessels, 
bowels,  also  those  in  all  organs.  It  also 
can  affect  the  salivary  and  mammary  glands, 
digestion,  excretion,  secretion,  and  general 
nutrition. 

The  mental  emotions,  which  largely  govern  Power  of 

1        •  r  •  1  ^^^  emo- 

the  sympathetic  system,  cause  functional  tions. 
diseases  of  all  parts  and  many  organic 
diseases — inflammations,  oedema,  goitre,  ex- 
ophthalmic goitre,  headache,  angina  pectoris, 
diabetes,  Addison's  disease,  and  neuroses  of 
the  extremities. 

So  much,  then,  for  an  outline  of  nerve  action. 

We  now  turn  to  the   causes  of  functional  Etiology 
nerve  diseases.     These  are  predisposing  and  disease. 
exciting. 

The   predisposing    cause  to  nerve   trouble  The  predis- 
is   principally  a   nervous  diathesis   or   dispo-  cause!" 
sition.    People  are  born  nervous  ;  that  is,  they 
are  born   with   the    nervous   system   unduly 


46  NERVES    IN    DISORDER 

predominant,  less  under  control,  less  orderly 
in  its  action  than  in  other  people.  No  doubt 
a  highly  developed  nervous  system  with 
adequate  control  is  the  best  type  for  a  man 
or  woman ;  but  without  this  control  he  or 
she  joins  sooner  or  later  the  ranks  of  nerve 
sufferers.      The  great   predisposing   cause   is 

Is  heredity,  therefore  heredity ;  but  (and  this  may  be 
noted  as  important),  if  the  family  history 
only  reveals  nervous  troubles  in  other  members 
as  distinguished  from  loss  of  mind  in  any 
form,  the  invalid,  however  severe  his  symptoms 
and  great  his  sufferings,  is  not  likely  to  cross 
the  border-line  of  sanity  to  the  other  side. 

The   exciting   causes    may    be   mental   or 
physical. 

Exciting  ^\\Q,  leading  mental  cause  of  nervous  disease 

causes. —  ° 

Worry.  is  worry,  first  and  foremost,  rather  than  work. 
Properly  regulated  brain-work  no  more 
leads  to  nerve  disease  than  hard  manual 
labour  leads  to  disease  of  the  muscles.  In- 
deed, it  is  so  far  from  injuring  the  nerves 
that  it  is  one  of  the  greatest  sources  of  their 
strength,  and  one  of  the  strongest  safeguards 
against  neurasthenia.  Worry,  however,  is 
an  unmitigated  evil ;  it  is  a  most  vicious  habit, 
doing  good  to  none,  but  invariably  damaging 


NEURASTHENIA  AND  NEUROMIMESIS     47 

more  or  less  the  nervous  system  of  the  one 
who  gives  way  to  it.  This  must  be  due 
to  the  constant  cross-currents  of  thought 
that  eddy  backwards  and  forwards  in  the 
brain,  and  to  real  fatigue  and  difficulty 
in  finding  the  resultant  that  shall  issue  in 
action  from  among  a  large  number  of  con- 
flicting forces. 

Next  to  worry  as  a  cause  of  nerve  disease,  Mental 

idleness, 

or  perhaps  bracketed  with  it,  we  should  be 
inclined  to  place  sudden  mental  idleness, 
such  as  school-girls'  experience  when  all  at 
once  transformed  at  the  close  of  the  last 
term  into  "  young  ladies."  The  sudden  change 
from  working  every  day  through  a  long  time- 
table containing  a  perfect  olla  podrida  of  more 
or  less  useful  subjects  to  the  peaceful  occupa- 
tion of  arranging  the  flowers  in  the  drawing- 
room  for  half  an  hour  daily,  has  a  very 
marked  effect  on  some  natures,  and  they 
readily  become  a  prey  to  nerve  disorders 
from  the  abrupt  cessation  of  brain-work. 
If  one  might  for  a  moment  play  the  part 
of  adviser  here,  one  would  suggest,  when 
school-days  are  over,  six  or  twelve  months 
of  modified  work  at  those  essentials  that  are 
invariably  left  out  of  the  school  time-table — 


48  NERVES    IN   DISORDER 

we  allude  to  domestic  duties  of  all  sorts, 
nature  lore,  hygiene,  and  other  household 
matters.  Six  months  at  the  House  of 
Education,  Ambleside,  under  Miss  Charlotte 
Mason  is  a  most  admirable  prophylactic  in 
these  circumstances. 

Strain  and  Long-continued  strain  from  any  reason  is 
another  cause,  and  so  is  overwork  of  all  sorts, 
especially  if  combined  with  under-feeding, 
as  is  so  common  in  the  poorer  classes.  Bad 
mental  surroundings,  such  as  association  with 
other  nerve  sufferers  or  anxious  or  fractious 
parents,  are  other  agents  ;  and  there  are  many 
more. 

Physical  TurninsT    to    the    physical   causes,    which, 

and  other  ° 

causes.  however,  generally  duly  act  in  conjunction 
with  mental,  we  would  place  first  general 
ill-health,  especially  if  dyspepsia  be  present ; 
too  much  food  or  too  little  food  may  come 
next ;  too  much  physical  work  is  seldom  a 
cause,  but  too  little  exercise  frequently  is. 
Sudden  change  of  surroundings  of  any  sort 
frequently  develops  nervous  disease,  as  when 
a  man  retires  from  business,  a  girl  gets  married, 
or  sudden  loss  of  or  increase  of  fortune  takes 
place.  Shock  arising  from  accidents,  bad 
news,   etc.,  is  a  cause  ;  so  is  extreme  grief 


NEURASTHENIA  AND  NEUROMIMESIS     49 

or  extreme  joy.     Such,  then,  are  the  principal 
sources  of  nerve  trouble. 

Now,  nervous  people  are  the  very  salt  of  Nervous 

people  the 

the  earth,  and  the  leading  men  in  every  pro-  salt  of  the 
fession  are  drawn  from  their  ranks.  They 
are  men  with  brains  that  thrill,  that  feel, 
that  are  quick  in  action,  firm,  clear,  and  of 
high  organisation.  It  is  the  nervous  men 
that  rule  the  world,  not  lymphatic  vegetables. 
Listen  to  an  impartial  sketch  of  the  type  : — 
"  The  skin  is  dark,  earthy,  pale,  or  may  be 
of  any  shade,  and  is  often  hot  and  dry.  The 
skull  is  large  in  proportion  to  the  face ; 
muscles  spare,  features  small,  eyes  quick, 
large,  lustrous  ;  circulation  capricious,  veins 
large.  Face  characterised  by  energy  and 
intensity  of  thought  and  feeling  ;  movements 
hasty,  often  abrupt  and  violent,  or  else 
languid.  Hands  and  feet  small,  frame  slight 
and  delicate.  Require  little  sleep,  drink 
much  tea.  Prone  to  all  nervous  diseases. 
Always  seem  to  be  able  to  do  more  than  they 
are  doing.  The  character  may  be,  on  the 
one  side,  admirable  for  its  powers  of  mind 
and  insight,  for  its  lofty  imagination  ;  while, 
on  the  other,  it  may  be  disfigured  by 
impetuous  and  unruly  passions.     To  this  class 

4 


50  NERVES    IN   DISORDER 

belong  the  most  intellectual  of  the  race — 
the  wittiest,  the  cleverest  of  mankind.  These 
are  the  poets,  the  men  of  letters,  the  students, 
the  professors,  or  the  statesmen.  Their 
great  dangers  consist  in  uncontrollable 
passions.  They  feel  pain  acutely.  Neverthe- 
less, they  can  endure  long  fatigue  and 
privation  better  than  the  sanguine.  They 
form  the  leaders  of  mankind.  Amongst 
women  there  is  delicacy  of  organisation, 
quickness  of  imagination,  and  fervour  of 
emotion ;  but  they  are  beset  vi^ith  danger, 
from  want  of  control  of  their  great  powers." 

Now,  it  is  the  children  of  these  people  who, 
inheriting  the  nervous  organisation  of  their 
parents  without  having  their  safety  valve 
of  hard  work,  so  often  fall  victims  to  nervous 
diseases. 

Details  of        Passing    now   from    generalities,    we    will 

neuras- 
thenia,       consider  a  little  more  in    detail  the  subjects 

of  neurasthenia  and  of  neuromimesis,  taking 

the   former   first.     In  neurasthenia  we    have 

to  do  with  every  variety  of  brain  and  nerve 

exhaustion  that  may  show   itself  physically 

in  many  various  movements  and  actions,  or 

mentally  in  every  form  of  "  nervousness  "  from 


NEURASTHENIA  AND  NEUROMIMESIS     51 

slight  irritation  to   extreme  nervous  debility 
and  different  varieties  of  nerve  aberration. 

Cases  of  true  neurasthenia,  that  is,  of  nerve  Causes  of 

,  .  ,  ,  neurasthe- 

irritation  or  exhaustion,  dependent  upon  niaand 
external  causes  or  on  some  bodily  illness, 
are  mainly  physical  in  their  origin  ;  the  mind, 
conscious  or  unconscious,  being  only  affected 
in  a  secondary  degree  as  a  result  of  the 
nerve  condition. 

On  the   other  hand,  all  cases  of  hysteria 
or  neuromimesis  contain  a  distinct  primary 
mental  element,  which  is  an  affection  of  the 
unconscious  mind  over  and  above  any  mere 
question  of  nerve  condition  ;  while  all  other 
cases  of  delusions,  fixed  ideas,  true  melan- 
cholia,  and   other   slight   aberrations,   reveal 
a  primary  disturbance,  want   of  balance   or 
unsoundness  of  the  conscious  mind  or  reason, 
and   these   are  generally  recognised  as  true 
mental  cases.     Hysterical  patients,  however, 
are    not    generally    regarded    as     distinctly 
mental,  owing  to  the  fact  that  still,  as  a  rule, 
in  England  mind  is  limited  to  consciousness. 
In  France  it  is  otherwise,  for  Charcot,  quoted 
by     F6r6,   says,    "  Hysteria    is    a    psychical 
malady  par  excellence^     In  this  country,  from 
the  fact  of  its  seat  being  the   unconscious 


52  NERVES    IN   DISORDER 

mind,  which  produces  in  the  body  the  sym- 
ptoms complained  of,  hysteria  occupies  an 
intermediate  place  between  the  pure  nerve 
lesions  on  the  one  hand  and  the  distinct 
mental  troubles  on  the  other. 

Neurasthenia  is  by  no  means  a  disease  of 

degenerates,  or  of  weak-minded  people,  any 

more   than    it   is    a    species    of    malingering. 

Neuras-      In  my  experience  the  larger  number  of  the 

thenia  in 

clever         victims  to  it  are  people  of  good   and   even 

people.  , 

great  mental  powers,  who  from  an  over-use 
of  these  very  powers,  or  at  times  from  a  want 
of  use  of  them,  have  fallen  a  prey  to  it. 

We  have  already  said  that  the  nervous  men 
rule  the  world,  and  those  of  this  temperament 
are  ever  the  ones  whose  nerves  are  most 
likely  to  break  from  their  control  from  over- 
strain and  other  causes,  and  hence  to  suffer 
from  neurasthenia  of  various  sorts. 

In  a  family  it  is  often  the  bread-winner 
who  is  so  afflicted,  or  perhaps  the  most 
intelligent  daughter. 

A  low  level  of  nervous  organisation  or  im- 
perfect education  is  not  often  a  cause  of  this 
disease ;  for  though  it  occurs  in  the  unedu- 
cated classes,  other  factors  are  generally  the 
predisposing  and   exciting   causes.      One   of 


NEURASTHENIA  AND  NEUROMIMESIS     53 

the  best  summaries  as  to  the  classes  affected  Classes  of 

neuras- 

has  been  made  by  Karl  Petren,  of  Upsala,  in  themes. 
the  Deutsche  Zeitschrift  fur  Nervenheilkunde, 
Bd.  xvii.,  who  reports  the  results  obtained  in 
a  recent  investigation  of  the  frequency  of 
neurasthenia  in  the  various  grades  of  society. 
Contrary  to  usual  statements,  he  does  not 
find  a  larger  number  of  cases  in  the  upper 
than  the  lower  classes.  Out  of  some  2,478 
patients  observed  between  1895  and  1899,  he 
met  with  285  (ii'5  per  cent.)  cases  of  definite 
neurasthenia.  These  he  resolves  into  three 
groups :  (i)  artisans  and  peasants ;  (2) 
tradesfolk  and  under-officials ;  (3)  intel- 
lectuals. In  further  division  as  to  sex, 
males  are  easily  first  with  (i)  I4"8  per  cent, 
(2)  13-2  per  cent,  (3)  I3'3  per  cent  As 
regards  women,  the  numbers  are  (i)  11 -4 
per  cent,  (2)  ^'6  per  cent.,  and  (3)  6'6  per 
cent  In  Sweden  it  therefore  now  appears 
that  neurasthenia  is  more  prevalent  amongst 
the  working  classes. 

On  the  other  hand,  many  cases  of  neur- 
asthenia are  put  down  to  education  ;  but 
we  must  remember  that  development  of  the 
nervous  system  makes  for  increased  control. 
It  is  found  by  Dr.  Allbutt  that  neurasthenics 


54  NERVES    IN   DISORDER 

are,  after  all,  not  more  common  in  New  York 
than  London,  or  among  the  busy  than  the  idle. 
The  disease  abounds  in  such  places  as  Fin- 
land, and  in  the  Yorkshire  collieries.  Petr^n 
thinks  that,  as  previous  writers  have  drawn 
their  statistics  on  the  one  hand  from  the 
higher  classes  and  on  the  other  from  clinics, 
the  results  disagree,  because  many  neuras- 
thenics do  not  come  under  hospital  treatment, 
whilst  those  of  the  former  status  readily 
Not  due  to  consult  their  doctors.  That  the  disease  is 
rush  of  life.  ^^^  dependent  upon  the  rush  of  modern  Hfe 
seems  apparent  from  the  fact  that  the  greater 
number  of  cases  came  from  the  provincial 
parts  of  Sweden,  where  life  is  very  simple 
and  tranquil. 
Causes  of  As  regards  causation,  62  cases  have  followed 
thenia."  family  disappointments,  24  financial  difficul- 
ties, and  47  overwork.  Twenty-nine  cases 
occurred  after  influenza,  21  acknowledged 
venery  and  other  various  exhausting  excesses  ; 
in  16  females  it  complicated  pregnancy  and 
the  puerperium,  8  were  directly  traced  to 
alcoholic  excesses,  and  2  were  produced  by 
high  temperatures  experienced  during  their 
avocations. 

A  prominent  factor  is  that  of  hereditary 


NEURASTHENIA  AND  NEUROMIMESIS  55 
alcoholism.    In  the  early  years  of  the  century  Effect  of 

'   '  ^  alcohol 

large  quantities  of  spirits,  etc.,  were  almost 
universally  consumed,  and  where  the  alcoholic 
tendency  is  not  directly  apparent  its  influ- 
ence is  felt  in  the  unstable  nervous  equilibrium 
of  the  present  generation.  Several  cases  are 
reported  in  which  cerebral  arteriosclerosis 
was  present.  Hygienic  conditions  also  con- 
tribute to  the  increase  amongst  the  lower 
classes.  Lack  of  proper  nourishment,  in- 
sanitary dwellings,  and  monotony  of  existence 
are  amongst  some  of  the  causes  that  need 
attention  in  order  to  prevent  its  further 
extension. 

We  need  not  repeat  here  the  list  of  pre- 
disposing and  exciting  causes ;  for  what  we 
have  given  as  those  of  general  functional 
nerve  disease  apply  equally  well  to 
neurasthenia. 

The  symptoms  of  this  disease  vary  as 
widely  as  the  classes  which  suffer  from  it. 
When  a  structure  such  as  the  nervous  system 
is  affected,  that  is  an  agent  in  nearly  every 
bodily  activity,  it  is  obvious  that  the 
symptoms  must  vary  with  the  part  where 
the  weakness  predominates. 

The  following  long  list,  made  of  the  more 


56  NERVES    IN   DISORDER 

prominent  of  these  symptoms,  clearly  shows 

this  :— 

List  of  Scalp  tenderness — headaches  (not  in  my  ex- 
symptoms 

ofneuras-  perience  a  common  or  a  prominent  symptom) 
thenia. 


lilated  pupils — feeling  of  pressure  on  the 
vertex — heavy  expression  of  eye — congested 
conjunctivae — alteration  of  the  nerves  of 
special  sense  (increased  or  diminished  capri- 
ciously)— muscae  volitantes — noises  in  the 
ears — atonic  voice — loss  of  mental  control — 
irritability — hopelessness — morbid  fears  of 
open  places,  of  crowds,  of  confined  spaces, 
of  being  alone,  of  people,  of  responsibilities, 
of  diseases,  of  infection,  of  trains  or  cabs,  of 
everything  (called  by  various  Greek  and 
other  compound  words,  agoraphobia,  claus- 
trophobia, etc.,  etc.) — blushing — insomnia  (a 
marked  symptom) — drowsiness  (in  visceral 
neurasthenia) — tender  teeth — dyspepsia — love 
of  drugs — abnormal  secretions— sweating  hands 
— tender  spine  —  tender  coccyx  —  irritable 
heart — tremors — dysphagia — irritable  cough 
— irregular  respiration  (sometimes  "  Cheyne 
Stokes  ")  —  cramps  —  morbid  sensibility  — 
numbness  —  hypersesthesia  —  exhaustion  — 
pruritus — flushes — cold  feet  and  hands — 
sudden  changes  of  condition  and  symptoms. 


NEURASTHENIA  AND  NEUROMIMESIS     57 
To   this   long   catalogue  I  may  add  from  Some 

°  °  ■'  addiUons. 

personal  experience :   constant  restlessness — 

defective  memory — dizziness  and  giddiness — 

dread  of  noise  or  light — loss  of  voice — loss 

of  sense  of  proportion,  small  things  looking 

big,  and  important  things   trifling — want  of 

co-ordination — palpitation     of     the     heart — 

weariness  of  brain — "pins   and  needles"   in 

limbs — left  sub-mammary  pain — left  inguinal 

pain — nervous   hand  (flexed  wrist,  extended 

fingers,  fine  tremors,  and  dropped  thumb) — 

flatulence,  and  constipation. 

Out   of  the   above  48  symptoms  we  may  Classifica- 
tion of 
class  26  as  functional,   1 5   as  mental,  and  7  symptoms. 

as  physical  or  to  a  certain  extent  organic. 

Neurasthenia,  after  all,  is  a  word  that  des- 
cribes two  very  difl"erent  types  of  nerve  disease,  Two  stages 

in  neuras- 

and  these  are  "  Nervous  Irritability "  and  thenia. 
"  Nervous  Debility."  The  seat  of  the  trouble 
in  either  case  may  be  in  the  spine  or  it  may 
be  in  the  brain ;  and  two  barbarous  words 
of  six  and  seven  syllables  have  been  coined 
to  express  each  variety  respectively,  with 
which  we  need  not  trouble  our  readers 
here. 

The   first   stage   of  "  nervousness^^   that  of 
nerve  irritability,  is  the  general  result  of  over- 


58  NERVES    IN    DISORDER 

strain  of  the  nervous  temperament,  and  is 
greatly  on  the  increase,  as  the  tension  of  life 
becomes  more  acute,  while  hysteria  proper  is 
diminishing.  Constant  brain  irritants  in  the 
ideal  centres,  in  the  shape  of  small  but  per- 
petual worries,  render  the  other  nerve  centres 
as  morbidly  sensitive  as  a  constant  succession 
of  slight  pin-pricks  all  over  the  body  would 
the  terminal  sensory  nerves.  The  manifesta- 
tions of  nervous  irritation  are  numerous  and 
characteristic. 
Symptoms       Physically  they  may  include   constant   or 

of  nerve 

irritation,  intermittent  movement  of  body  and  face, 
sharp  ringing  cough,  sudden  hoarseness,  quick 
and  irregular  breathing,  starting,  twitching, 
flushing,  palpitation  of  the  heart,  tenderness 
of  the  scalp  or  spine,  headaches  at  the 
top  and  back  of  the  head,  congested  look 
of  the  eyes,  noises  in  the  ears,  sleeplessness, 
dyspepsia  and  flatulence,  perspiration,  flying 
pains  and  cramps,  and  neuralgia  in  various 
parts. 

Mentally,  we  get  timidity,  irritability, 
melancholy,  and  a  dread  of  being  alone,  or 
"  monophobia  "  ;  or  in  a  crowd,  or  "  agora- 
phobia " ;  or  in  close,  confined  spaces,  or 
"  claustrophobia."     There     is     little     mental 


NEURASTHENIA  AND  NEUROMIMESIS     59 

control    or   power;    wrong    words    may    be 
spoken  or  written. 

Referring  to  the  divisions  of  the  brain,  the 
cause  may  be  said  to  be  largely  the  result 
of  want  of  control  by  the  upper  or  cortex 
over  the  middle  district,  which  may  be  due 
to  inherent  weakness  or  constant  irritation 
from  overwork  or  worry,  or  daily  railway 
travelling.  The  constant  movement  charac- 
teristic of  this  condition  is  in  itself  a  sign 
of  weakness  in  the  higher  centres.  A  baby 
is  always  in  motion.  As  we  grow  older  we 
get  quieter,  and  the  man  with  the  strong  Repose  a 
brain  only  moves  for  a  definite  purpose.     Re-  brain 

power. 

pose,  not  movement,  is  a  sign  of  bram  power. 
These  cases  are,  in  spite  of  what  we  have 
said,  generally  called  "  hysterical  "  or  "  hypo- 
chondriacal " ;  and  the  real  affection,  which 
is  "  nerve  irritation,"  is  still  rarely  found  in 
medical  works  as  a  distinct  disease,  although 
all  the  symptoms  clearly  point  to  it,  which  in 
hysteria  they  do  not ;  for  although  the  latter 
disease  is  a  nervous  one,  it  generally  appears 
to  be  organic.  This  first  stage  of  nervousness, 
if  the  cause  that  produced  it  is  still  there,  and 
no  treatment  is  adopted,  progresses,  either 
naturally  to  the  second  stage,  or  abnormally 


6o  NERVES    IN   DISORDER 

to  general  neuralgia,  inebriety,  etc.,  or   even 
insanity. 
Nervous  Before  considering  the  treatment  we  will 

briefly  describe  the  symptoms  of  the  second 
stage  of  neurasthenia,  viz.  "  nervous  debility." 
This  is  a  still  worse  disorder.  It  is  the 
manifestation  of  nerve  exhaustion  rather  than 
irritation,  and  is  generally  a  further  stage  of 
nervousness.  It  is  the  frequent  result  of 
excesses  of  all  kinds.  It  is  characterised 
by  physical  weakness,  dilated  and  sluggish 
pupils,  dimness  of  sight,  general  exhaustion, 
mental  lassitude  and  apathy,  occasionally 
varied  by  a  false  and  capricious  but  evanescent 
energy.  It  is  often  combined  in  varying 
degrees,  as  would  naturally  be  supposed, 
with  nervous  irritability,  and  frequently  with 
hysteria. 

So  far  from  moving  about,  the  patient  is 
quite  still,  and  becomes  increasingly  difficult 
to  arouse  to  an  interest  in  his  surroundings 
The  symptoms  in  both  stages  are  very  vari- 
able at  first,  but  tend  to  become  increasingly 
fixed  as  time  goes  on. 

Nenro-  Turning    now  to  neuromimesis,  we   must 

mimesis  °  ' 

f^^   .       define  its  relationship  with  the  word  "hysteria," 


NEURASTHENIA  AND  NEUROMIMESIS     6i 

a  word  which,  from  its  misuse,  as  we  have 
pointed  out,  would  be  much  better  dropped, 
if  it  were  possible.  Hysteria  by  some  is 
made  to  cover ,  every  form  of  functional 
nerve  trouble,  including  hypochondria  and 
melancholia,  as  well  as  neurasthenia  and 
neuromimesis. 

Others  again  restrict  it  to  the  last  two. 
Those  who  use  the  word  rightly,  restrict  it 
to  a  disease  of  narrowed  consciousness,  char- 
acterised by  defects  of  vision  and  sensation, 
and  at  times  convulsive  attacks  of  various 
characters ;  the  mimicry  of  disease  being 
better  described  under  the  head  of  neuro- 
mimesis. 

Here,  however,  we  shall  often  have  to  use 
the  word  "  hysteria  "  to  include  neuromimesis, 
in  accordance  with  the  usual  practice  at 
present. 

Speaking  then  generally  of  hysteria  in  this  Seat  is  in 
broad  sense,  we  may  say  that  the  seat  of 
this  disease  in  every  case  is  really  in  the 
brain,,  where  it  either  actually  originates 
or  is  caused  by  irritation  from  some  part 
of  the  body  that  may  be  slightly  diseased. 
This  real  seat  of  the  disease  is,  however, 
seldom    suspected    by    the    patient    or    the 


62  NERVES    IN    DISORDER 

friends,  who  are,  as  we  have  shown,  constantly 
misled — as,  indeed,  the  physician  may  himself 
be  led  into  error  by  the  remarkable  appear- 
ances of  disease  which  it  produces  in  various 
parts  of  the  body.  There  may,  of  course, 
be  real  organic  disease  as  well,  and  the  two 
may  be  combined  in  any  proportions. 

Hysteria  is  so  common  that  in  some  affec- 
tions, such  as  pain  in  the  back,  it  is  the 
general  cause,  organic  disease  being  the 
exception.  We  find  hysterical  sufferers  in 
all  our  hospitals,  amongst  our  friends  in  all 
circles  of  society,  and  all  over  the  Continent. 
They  used  to  fill  our  watering-places  with 
interesting  invalids  in  bath-chairs,  who  are, 
however,  now  comparatively  rarely  seen,  the 
cause  of  the  disease  being  more  generally 
known. 
Pain  the  One  symptom  of  hysteria  is  generally /^/« 

symptom    of  some  sort  having  the  character  of  distinct 
m  hysteria,  ^jgg^gg — ^  jjj  ^.jjg  chest  resembling  pleurisy, 

in  the  heart  resembling  a  form  of  heart 
disease,  in  the  spine  resembling  spinal  disease, 
in  the  knee  resembling  rheumatic  gout,  or 
elsewhere.  In  such  cases  even  the  skin  is 
tender,  and  a  slight  touch  hurts  as  much  as 
a  heavy  one,  which  is  not  the  case  in  local 


NEURASTHENIA  AND  NEUROMIMESIS     63 

disease.  Or,  on  the  other  hand,  any  part 
of  the  body,  whole  limbs  or  isolated  patches, 
may  be  insensible  to  pain,  and  be  pricked 
without  its  being  felt.  This  pain,  we  repeat, 
differs  in  its  origin  from  all  other,  being 
neither  neuralgia  (or  pain  arising  in  the  nerve 
itself),  nor  caused  by  any  body  disease  ;  but, 
arising  in  the  ideal  centres  of  which  we 
have  spoken,  it  is  probably  transferred  by 
vibration  to  the  nerve  centre  belonging  to 
that  part  of  the  body  with  which  the  idea 
is  occupied,  and  the  pain  is  referred  to  the 
nerves  connected  with  this  centre  that  com- 
mence in  that  part  ot  the  body  where  the 
pain  is  said  to  be  felt  and  the  disease  sup- 
posed to  exist. 

As  to  this  internal  causation  we  may  use  The  cause 
again  a  familiar  illustration.  It  is  true  that,  brail.'" 
however  much  the  hall-door  bell  may  ring, 
though  we  always  say  there  must  be  some 
one  there,  this  by  no  means  follows.  Now 
a  slight  disease  in  fact,  as  a  sprained  knee ; 
or  in  memojy,  as  the  continual  painful  re- 
collection of  one ;  or  in  association,  as  con- 
tinually hearing  about  one,  or  reading  about 
one,  or  seeing  one,  may  so  cause  the  centres 
in  the  brain  connected  with  the  pain,  swelling, 


64  NERVES    IN   DISORDER 

and  stiffness  of  the  joint  to  vibrate,  that 
the  vibration  is  kept  up  without  any  actual 
disease  being  present,  or  long  after  it  has 
ceased  to  exist. 

We   must   remember   that   while   we  may 

be  wrong,  when  the  door-bell  rings,  in  saying 

there    is    some    one    there,    we   are   certainly 

wrong,  if  we  go  there  and  find    no   one,   in 

It  is  wrong  saying  it  is  nothing  at  all.     And  yet  we  know 

to  describe   ....  ,.,.,.  .  ,  ,  , 

"brain  it  IS  this  v/hich  IS  bcmg  Said  every  day  by 
nothing  at  some  doctors,  through  want  of  any  training 
in  these  matters,  combined  with  too  great 
training  in  believing  only  in  what  they  can 
see  or  feel  or  hear.  If  such  men  find  there 
is  nothing  wrong  with  the  knee-joint,  how- 
ever loudly  the  patient  may  complain,  they 
declare  and  stick  to  it  that  he  has  nothing 
wrong  with  him,  and  suggest  that  the  patient 
does  not  really  feel  the  pain  at  all ;  or,  in 
other  words,  that  the  bell  never  rang. 

Now  the  bell  did  ring,  and  the  disease 
does  exist ;  only,  instead  of  being  a  common 
affection  or  disease  of  the  knee,  it  is  an 
obscure  one  of  the  brain.  See  what  an 
injury  is  unconsciously  inflicted  on  a  nervous 
sufferer,  who,  feeling  agonising  pain  in  the 
knee  or  back,  is  first  well  pulled  about,  and 


NEURASTHENIA  AND  NEUROMIMESIS     65 

then,  because  nothing  can  be  felt  at  the  spot, 
is  calmly  told  that  nothing  is  the  matter,  and 
is  sent  away  with  the  diseased  ideal  or  other 
centre  in  the  brain  uncured. 

Let  us  now  briefly  run  over  the  symptoms 
of  emotional  hysteria  proper,  and  then  those 
of  simulating  hysteria  or  neuromimesis. 

Amongst     the     symptoms     of    emotional  Symptoms 

°  -'       jr  of  true 

hysteria  may  be  included  sharp  cough,  emotional 
spasms,  convulsions,  and  choking  from  a 
ball  rising  in  the  throat ;  laughing  immode- 
rately and  crying,  or  both  together ;  sudden 
movements  more  or  less  purposeless.  The 
spasms  may  be  local  or  general,  or  of  any 
groups  of  muscles, — as  of  the  chest,  producing 
difficulty  of  breathing  with  signs  of  suffo- 
cation ;  or  of  the  arm,  or  leg,  or  finger, 
or  toe,  producing  temporary  or  permanent 
contraction  of  the  part :  these  symptoms  are 
made  worse  by  sympathy,  which  simply 
feeds  the  vitiated  ideal  centres.  The  con- 
vulsions or  hysterical  fits  are  violent,  and 
are  usually  ushered  in  by  suffocation  and 
pain  on  the  rising  of  the  "  globus  "  or  ball 
in  the  throat.  The  attacks  are  not  very 
sudden,  there  being  generally  some  struggling 
first.     The  patient  then    often   shrieks,  and 

5 


66 


NERVES    IN   DISORDER 


Simula- 
tions of 
hysteria, 
or  neuro- 
mimcsis. 


becomes  partly,  not  wholly,  unconscious, 
the  fit  being  aggravated  by  any  notice  or 
sympathy,  for  which  there  is  often  a  great 
desire.  The  patient  falls  without  hurting 
herself,  and  the  fit  rarely  occurs  in  the 
night  or  when  there  are  no  bystanders. 
Nevertheless,  the  hysterical  convulsion  is  in 
no  sense  a  sham.  The  back  is  generally 
arched,  which  is  rare  in  epilepsy,  and  the 
movements  and  language  are  more  or  less 
purposive.  The  tongue  is  not  bitten.  There 
may  be  several  fits  or  only  one. 

Mimetic  or  imitative  hysteria,  neuromimesis, 
is  not  characterised  by  these  attacks  or  general 
sensations,  but  simulates  every  known  disease, 
including  tumours,  deafness,  blindness,  dumb- 
ness, paralysis,  St.  Vitus'  dance,  etc.,  and  is 
capable  of  producing,  curiously  enough,  the 
highest  temperatures  of  fever.  In  every 
case,  though  so  various  in  their  manifesta- 
tions, it  is  probable  that  the  cause  is  the  same  ; 
and  that  the  disease  is  first  unconsciously 
pictured  in  the  ideal  centres,  either  from 
these  being  abnormally  excited  or  disordered, 
or  from  some  slight  pain  or  symptom  in  the 
body  suggesting  the  disease ;  or  from  fear  of 
the  disease,  or  seeing  it  in  others,  or  having 


NEURASTHENIA  AND  NEUROMIMESIS     67 

it  suggested  to  the  mind  :  and  that  in  these 
ideal  centres  the  impression  is  so  profound 
that  the  disease  is  not  only  believed  by  the 
sufferer  to  exist  in  the  body,  but  that  its 
symptoms  are  absolutely  but  unconsciously 
reproduced,  by  transference  from  ideal  to 
motor  and  sensory  nerve  centres,  with  such 
amazing  accuracy  as  often  to  deceive 
physicians  themselves. 

There   is   in    neuromimesis  a  distinct   dis-  Hysterical 

and  insane. 

order  of  the  "unconscious  mind."  A  man 
whose  "  conscious  mind  "  is  diseased  is  called 
insane  ;  but  one  whose  "  unconscious  mind  " 
is  affected  is  not  regarded  as  insane,  but  as 
'  hysterical,"  which  to  some  is  a  worse  name 
than  the  other.  The  delusions  may  be 
equally  strong  in  both  cases  and  the  results 
on  life  almost  as  disastrous,  and  yet  it  is 
quite  true  that  a  man  is  not  insane  if  he  has 
only  "hysteria."  This  nomenclature  should 
not  be  disturbed,  and  the  word  "  insanity ' 
h  ould  not  be  allowed  to  cover  any  disorders 
below  consciousness.  In  the  present  instance 
we  have  nothing  to  do  with  diseases  of  the 
conscious  mind,  and  I  do  not  write  of  the 
insane  at  all.  Let  it  be  understood,  therefore, 
that    in    neuromimesis   we    get    unconscious 


68  NERVES    IN   DISORDER 

ideal    centres,    with    or    without   "  fits,"   but 
with    the    unconscious    reproduction   of    the 
symptoms  of  some  definite  disease, 
ne^fs^not       Hysteria  is   therefore,  in  the   broad  sense, 
hysteria,      ^    disease    that    manifests     itself    either    in 
exaggerated  emotional  displays  with  fits,  or 
in  the  accurate  but  unconscious  mimicry  of 
known  diseases.    It  will  thus  be  seen  that  it  is 
widely  different  from  "  nervousness,"  or  neu- 
rasthenia, with  its  long  train  of  well-marked 
nerve  symptoms  that  suggest  no  disease  but 
the  one  that  is  there.     In  neuromimesis  there 
is  no  intention  to  deceive ;  and  it  must  care- 
fully be   distinguished    from   malingering   or 
shamming,  which  is  a  direct  attempt  at  fraud, 
and   for  which  no  contempt   or  ridicule   can 
be  too  severe,  though  of  course  the  two  may 
at   times    coexist.     The    essential    difference 
that  determines  the  question  of  fraud  is  that 
in  hysteria  the  power  that  perfectly  produces 
the   symptoms   of  the  disease  is  the  uncon- 
scious  mind,   a   force   of  which   the  sufferer 
is  necessarily  wholly  ignorant.     In  the  latter, 
the  agent  that  clumsily  feigns  some  disease 
is  the  conscious  mind,  of  which  the  patient 
is  cognisant  and  for  which  he  is  responsible, 
and  this  alone  constitutes  fraud. 


NEURASTHENIA  AND  NEUROMIMESIS     69 

Cases   of    neuromimesis   occur  usually   in  .^y^^?"^ '° 

lU-baJanced 

an   ill-balanced   or  starved    brain ;    so   that,  brains. 
although  the  conscious  mind  is  not  unhinged 
or  absolutely  diseased,  it  is  often  weak  and 
erratic — a  condition  that  also  lends  itself  to 
the  appearance  of  fraud. 

Suppressed    gout — i.e.   the    uric  acid   dia-  "Sup- 

pressed  " 

thesis   that  has   not   exploded   in    an   acute  gout  and 

,  ,       .  .       ,  •       T  1  hysteria. 

attack — producing  as  it  does  tinglings,  burn- 
ings, pains,  and  pressures,  and  other  morbid 
sensations  in  various  parts  of  the  body, 
has  been  very  justly  pointed  out  by  Sir 
James  Paget  as  a  fertile  exciting  cause  of 
neuromimesis. 

Hysteria  is  thus  often  the  result  ot 
some  slight  but  real  disease  in  a  person 
with  an  ill-balanced  or  worn-out  brain; 
and  this  slight  but  real  disease  sets  up  a 
train  of  associations  that  produce  true 
neuromimetic  disease — that  is,  a  disease 
the  seat  of  which  appears  to  be  in  the 
body,  but  is  really  in  the  brain.  Hysteria 
is  most  common  in  the  spring,  when  the 
nervous  system  is  least  well  balanced.  It 
is  common  in  the  under-  and  over-worked, 
in  the  badly  trained  and  imperfectly  edu- 
cated ;  in  boys  from  ten  to  fourteen,  in  girls 


70  NERVES    IN   DISORDER 

from  sixteen  to  twenty-five,  and  in  spinsters 

at  any  age. 

Over-education    and    subsequent    idleness 

combined    are    fertile    causes.      It    is    often 

found  in  people  otherwise  strong-minded  and 

clever.      The     mental    characteristics    found 

in  these  sufferers  are  thus  described  by  Dr. 

Buzzard : — 

Dr.  ••  Intelligence    good,    apprehension    quick, 

Buzzard  ,       .     ,  i  i-i- 

on  the  memory  good,  judgment  weak,  no  ability 
^^^'^  '  of  concentration  of  thought  for  any  length 
of  time.  Accuracy  and  perseverance  are 
deficient.  Emotions  too  easily  excited,  and 
incapable  of  control.  The  expression  of 
emotion  is  incongruous — tears  at  ridiculous 
subjects  and  laughter  at  tragic.  There  is 
great  desire  for  the  sympathy  and  attention 
of  others.  Sometimes  there  is  exaggeration 
in  varying  degree,  which,  however,  is  probably 
a  part  of  the  disease." 

This  last  point  must  be  noted.  For  while 
there  can  be  no  doubt  that  many  of  the 
feelings,  such  as  pain,  are  exaggerated,  we 
must  remember  on  the  one  hand  that  they 
are  certainly  felt,  and  on  the  other  that 
Hysterical  the  very  exaggeration  is  a  proof,  not  of 
fraudulent,  fraud,  but,  as  we  have  said,  of  the  ill-balanced 


NEURASTHENIA  AND  NEUROMIMESIS     71 

working  of  the  judgment  and  perceptive 
powers  of  the  brain. 

I  will  now  give  a  few  typical  examples  of 
neuromimesis,    selected    from   hospitals    and 
published    cases    rather   than   from   personal 
private  practice,  for  obvious  reasons. 
Joint  Disease. — Skey  records  a  case   of  a  Hysterical 

''  •'  joint 

young  lady  of  nineteen  whose  knee  so  de-  disease. 
ceived  him  that  he  actually  recommended 
amputation ;  when,  suddenly  making  up  her 
mind  one  day  to  attend  the  wedding  of  her 
sister,  she  got  up  and  walked,  and  the  disease 
was  cured.  Sir  Benjamin  Brodie  said  that 
four-fifths  of  the  cases  of  knee-joint  disease 
amongst  the  rich  are  hysterical,  and  Sir 
James  Paget  that  one-fifth  amongst  the 
poor  are   so. 

What  is   so  remarkable  about  these  joint  Changes  in 

.  the  joint. 

cases  IS  that,  not  only  are  pam  and  stiffness 
complained  of,  but  the  continual  attention 
directed  by  the  sufferer  to  the  joints  may  pro- 
duce actual  enlargement  and  heat.  A  short 
time  ago  a  young  lady  came  up  with  a  large 
swelling  on  her  knee  to  see  one  of  our  most 
celebrated  surgeons  ;  and  he,  failing  to  re- 
cognise the  functional  character  of  the  disease 
in  the  brain,  so  complete  was  the  resemblance 


7a  NERVES   IN   DISORDER 

to  joint  disease,  told  her,  like  Skey,  that  the 
leg  must  be  amputated,  or  at  any  rate  the 
knee-joint  resected.  Her  distress  was  very 
great,  and  as  she  was  out  of  health  she  was 
told  to  go  to  Brighton  for  a  few  weeks  first, 
to  get  her  health  restored.  She,  however, 
drove  off  to  another  surgeon,  who  fortunately 
had  made  a  study  of  hysteria  ;  and  he  dis- 
covered the  true  seat  of  disease,  and  in  a 
few  weeks  the  "knee,"  or  rather  brain,  was 
cured,  and  no  amputation  needed.  Joints 
are  hysterically  affected  in  the  following  order 
of  frequency  :  the  knee  most,  then  the  hip, 
wrist,  ankle,  and  shoulder. 
Hysterical       Spinal  Disease   and  Paralysis. — Sir   Ben- 

spinal  -^  "^ 

disease,  jamin  Brodie  was  called  to  a  young  lady 
who  had  had  hysterical  spinal  disease  for 
six  years,  and  for  four  years  had  been  lying 
on  her  face  on  a  curious  wooden  machine 
made  for  the  purpose,  where  she  ate  and 
slept.     He  cured  her  in  a  few  weeks. 

Dr.  Reynolds  tells  an  affecting  story  of 
a  young  lady  whose  father  was  paralysed, 
and  who  so  feared  the  same  would  happen 
to  herself  that  she  gradually  lost  the  use  of 
both  legs  and  became  a  helpless  cripple.  On 
the  cause  being  proved  to  her  to  be  purely 


NEURASTHENIA  AND  NEUROMIMESIS     73 

mental,  in  five  days  she  sat  up,  and  after  a 
fortnight  walked  a  quarter  of  a  mile. 

A  woman  was   brought  on  a   couch   into  And     _ 

°  ■  _      paralysis. 

a  London  hospital  by  two  ladies,  who  said 
she  had  been  suffering  from  incurable 
paralysis  of  the  spine  for  two  years,  and 
having  exhausted  all  their  means  in  nursing 
her  they  now  sought  to  get  her  admitted, 
pending  her  removal  to  a  Home  for  In- 
curables. After  two  hours'  treatment  I 
walked  with  the  woman  half  a  mile  up  and 
down  the  waiting-room,  and  she  returned 
home  in  an  omnibus,  being  completely  cured. 
An  amusing  case  is  that  of  a  paralysed  girl, 
who,  on  learning  that  she  had  secured  the 
affections  of  the  curate  that  used  to  visit 
her,  got  out  of  bed  and  walked,  cured ;  and 
afterwards  made  an  excellent  pastor's  wile. 

A  remarkable  instance  of  this  sort  of  cure 
is  that  of  a  child  afflicted  with  paralysis,  who 
was  brought  up  from  the  country  to  Paris 
to  the  Hotel  Dieu.  The  child,  who  had 
heard  a  great  deal  of  the  wonderful  me- 
tropolis, its  magnificent  hospitals,  its  omni- 
potent doctors,  and  their  wonderful  cures, 
was  awe-struck,  and  so  vividly  impressed 
with   the  idea  that  such  surroundings  must 


74  NERVES    IN    DISORDER 

have  a  curative  influence,  that  the  day  after 

her  arrival  she  sat  up  in  bed,  much  better. 

The  good  doctor  just  passed  round,  but  had 

no  time  to  treat  her  till   the  third  day,   by 

which  time,  when   he   came  round,  she  was 

out  of  bed  walking   about  the   room,   quite 

restored  by  the  glimpses  she  had  got  of  his 

majestic  presence. 

Cure  of  a         Dr.  Dale  tells  us  of  the  wife  of  a  medical 
case. 

man   with   hysterical   paralysis   of    her  legs. 

She  was  told  it  was  due  to  her  mind,  and 

to   overcome   it    by    force    of  will   (a   futile 

suggestion)  :  she  could  not,  and  went  about 

in  a   bath-chair.      One   summer   a   drunken 

Highlander  tried   to  kiss   her  ;    she  jumped 

up  and  ran  off,  cured,  to  her  husband.     Here 

we  see  most  instructively  the  impotence  of 

the  conscious   will-power,  and   the   force   of 

the  unconscious  mind  the  moment  there  is 

a  suggestion  strong  enough  to  reach  it. 

This  is  the  class  of  disease,  as  distinguished 
from  neurasthenia,  where  sudden  and  sensa- 
tional cures  are  possible  and  common,  and 
often  in  appearance  seem  almost  miraculous. 

Cases  of  this  sort,  that  come  under  the 
head  of  hysteria,  including  especially  paralyses 
of  various  kinds,  are  so  exceedingly  common 


NEURASTHENIA  AND  NEUROMIMESIS    75 

that   there   is    no   need   to   give   further  ex-  Varieties  of 

°  paralysis. 

amples.  Suffice  it  to  say  that  there  is  no 
form  of  paralysis  that  is  not  simulated  by 
hysteria,  from  the  loss  of  power  in  a  single 
finger  or  joint  to  the  total  paralysis  of  one 
side,  or  of  both  legs,  or  of  the  entire  body. 
The  pain  may  be  in  any  part  of  the  spine,  but 
is  generally  about  the  "  small "  of  the  back. 

In  hysterical  paralysis  the  muscles,  as  a 
rule,  do  not  waste  much,  and  no  bed-sores 
ever  form.  If  the  helpless  limb  is  bent  it 
often  remains  so ;  which  would  not  be  the 
case  in  true  paralysis. 

This  paralysis  may  also  affect  any  or  all  Paralysis 
of  the   special    senses.     It   may   cause   such  special 

senses 

total  loss  of  taste  for  years  that  the  most 
nauseous  substance  can  be  eaten  without 
disgust.  It  may  cause  total  loss  of  smell, 
so  that  neither  garlic,  coal  gas,  asafoetida, 
nor  otto  of  roses  can  be  smelt.  It  may 
cause  squint  of  one  or  both  eyes,  or  colour 
blindness,  or  any  sort  of  imperfect  sight.  It 
may  cause  deafness  in  every  degree.  It  may 
cause  loss  of  feeling  or  touch  anywhere,  and 
the  part  may  be  pricked  or  cut  without 
being  felt. 

Tumours. — Tumours     of     all     sorts     are 


76  NERVES    IN   DISORDER 

Hysteriaxi  Simulated  with  a  fidelity  that  is  absolutely- 
startling,  and  skilled  doctors  are  constantly 
being  deceived.  They  may  occur  in  any 
part  of  the  body,  but  are  most  common  in 
the  breast  and  abdomen.  In  the  breast  severe 
pain  is  complained  of,  and  a  hard  mass  may 
be  felt,  which,  however,  disappears  if  the  hand 
be  laid  flat  upon  the  part.  Not  so,  however, 
with  those  in  the  abdomen.  Hysterical 
patients  with  perverted  nerve  centres  have  an 
unconscious  power  of  either  contracting  part 
of  a  single  abdominal  muscle  so  rigidly  that 
it  forms  a  hard,  round,  solid  swelling,  plainly 
perceptible ;  or  they  can  spasmodically  con- 
tract the  digestive  canal  at  two  points  so  as 
to  imprison  between  them  a  largely  distended 
portion,  which,  being  filled  with  flatus  and 
partly  movable  and  easily  felt  in  the  ab- 
dominal cavity,  is  exactly  like  an  abdominal 
tumour.  If  the  person  be  thin  and  the 
tumour  be  pressed  down  or  resting  on 
the  abdominal  aorta,  the  pulsations  from 
the  blood-vessel  are  so  perfectly  communi- 
cated to  the  false  tumour  that  it  is  believed 

to   be   an   aneurism.     I  was   told  by  one  of 
Fifty 
cases  of      our   bcst-known   physicians    that   fifty   cases 

hvstcricsLl 

tumours,      had   been   sent   in    to   his    hospital    of   this 


NEURASTHENIA  AND  NEUROMIMESIS     ^^ 

form  of  pulsating  tumour  as  abdominal 
aneurisms  ;  all  of  them,  previous  to  admission, 
having  been  examined  and  certified  to  be 
such  by  medical  men  ;  and  yet,  on  further 
examination,  every  one  of  them  turned  out 
to  be  of  hysterical,  and  not  local,  origin. 
The  only  way  in  which  they  can,  in  many 
cases,  be  found  out  is  by  ansesthetising  the 
patient,  when  the  tumour  generally  disap- 
pears, but,  of  course,  returns  immediately  the 
patient  regains  consciousness.  I  remember 
in  hospital  practice  one  special  case  of  this 
sort  under  my  care  of  a  woman  whose 
whole  abdomen  was  greatly  distended  by  a 
supposed  tumour  of  enormous  size.  Under 
chloroform  it  at  once  disappeared,  but  on 
regaining  consciousness  there  it  was  as  large 
as  ever.  The  woman  was  not,  therefore, 
"  cured,"  and  it  was  no  comfort  to  her  to 
know  that  when  she  was  unconscious  the 
swelling  was  not  there ;  all  she  wished  was 
to  be  relieved  ot  it.  I  therefore  put  her  Cure  of  i 
under  chloroform  again,  and  while  uncon- 
scious tightly  bound  her  round  with  plaster- 
of-Paris  bandages,  that  I  allowed  to  set  as 
hard  as  stone  before  she  regained  conscious- 
ness.     This   time,  of  course,   she  could  not 


78  NERVES    IN    DISORDER 

expand,  and  the  "  tumour  "  was  gone.  She 
was  delighted  we  had  "  removed "  it  ;  and 
after  keeping  the  bandage  on  for  three  weeks 
to  accustom  her  to  the  idea  she  was  well, 
and  so  stop  the  morbid  process  in  her  un- 
conscious mind  that  had  produced  it,  it  was 
taken  off,  and  the  woman  left,  most  thankful 
to  be  relieved  of  her  distressing  complaint. 
Spasm  of         special  affections. — A  young  lady  tottered 

the  gullet.     .  ,  .  ,  .  . 

mto  the  out-patient  department  oi  one  of 
our  large  London  hospitals  not  long  since, 
followed  by  her  mother  in  an  agony  of  mind, 
having  an  open  tin  of  "  Brand's  "  in  one  hand 
and  a  spoon  in  the  other.  She  had  brought 
this  because  her  daughter  was  dying  from 
a  contraction  of  the  gullet,  and  she  wished 
to  show  us  that  not  even  a  little  jelly  could 
be  swallowed.  The  girl  was  reduced  to  a 
skeleton,  and  would  certainly  have  died  from 
neuromimesis  if  not  relieved  ;  for  there  can 
be  no  doubt  that  people  die  solely  from 
hysterical  affections,  though  some  may  ques- 
tion it.  After  using  appropriate  means  to 
affect  the  mind  indirectly,  in  about  half  an 
hour  the  patient  was  sitting  in  one  of  the 
wards  eating  a  large  plateful  of  boiled  mutton, 
potatoes,  and  turnips,  with  "  hospital  pudding  " 


NEURASTHENIA  AND  NEUROMIMESIS     79 

to  follow.  It  is  cases  like  these,  seen  by 
men  wholly  ignorant  of  the  powers,  and 
perhaps  of  the  existence,  of  the  unconscious 
mind,  that  are  necessarily  considered  fraudu- 
lent and  the  patients  "  malingerers." 

A  matron  of  an  important  institution  had  Hysterical 

aphonia. 

to  resign  her  post  and  a  large  salary  through 
total  loss  of  voice.  Examination  showed 
that  this  was  hysterical,  for  when  she  coughed 
she  phonated,  and  the  vocal  cords  were  perfect 
in  action.  Appropriate  means  in  a  fortnight 
completely  restored  the  lost  voice. 

Hysterical  vomiting  is  very  common,  and 
often  persists  for  months  ;  the  patient,  however, 
does  not  lose  as  much  weight  as  would  be 
expected.  The  appetite  may  be  greatly 
perverted  ;  it  may  be  enormous,  or  entirely 
absent,  or  depraved — all  sorts  of  things  being 
swallowed.     Symptoms   of  obscure  diseases,  other 

diseases. 

such  as  hardenings  or  softenings  of  the  spinal 
cord,  that  could  not  be  known  consciously 
to  the  patient,  and  consisting  of  tremors, 
rigidity,  spasms,  etc.,  in  special  parts  of  the 
body,  are  produced  by  hysteria,  and  may 
persist  for  months ;  and  only  slight  incon- 
sistencies reveal  that  they  are  hysterical  after 
all.     But  I  must  not  dwell  further  on  these 


8o  NERVES    IN   DISORDER 

cases,  only  repeating  that,  on  thinking  over 

even  these  few  instances,  it  will  be  felt  how 

readily  the  idea  of  deception  comes  to   the 

mind.      It   is   only   when  the   real   aetiology 

of  the  disease  is  grasped  that  such  an  idea 

is  seen  to  be  inadmissible. 

Symptoms       Indeed,  without  a  knowledge  of  the  cause 

appLr       of  the    disease,    the    appearances    are    often 

fraudulent,  g^  consistent  with  fraud  that  one  cannot  so 

much  blame   the  doctor  who  suspects   this 

as   the   medical   training  which  has  allowed 

him    to  fall  into   the   error.     We   must   also 

remember   that   malingerers  abound,    drawn 

frequently  from  the  ranks  of  nerve  patients, 

who    produce    artificial   wounds   and    sores, 

and     feign     illnesses.      Of    course,    this     is 

common  amongst  soldiers  and  sailors,  but  is 

not  uncommon  in  educated  people ;  and,  to 

make   matters  worse,  some  cases  are  partly 

fraudulent    and    partly    hysterical,    and    the 

distinction    is    not    always    easy.      I    have, 

however,  throughout  been   speaking  of  real 

cases  only,  and  that  is  why  I  have  written 

so  strongly  of  their  treatment  as  unreal  from 

an  ignorance  of  the  aetiology. 

It  will  be  observed  here,  and  will  be  noticed 
again  further  on,  that  the  unfortunate  word 


NEURASTHENIA  AND  NEUROMIMESIS     8l 

"  hysteria,"  which  we  confessedly  use   to  in-  Neuro- 

•'  mimesis  is 

elude  "  neuromimesis,"  actually  covers  a  good  more  than 

.      .  r     !•  T     mimicry. 

deal  more  than  the  mimicry  of  disease.  In 
many  of  the  instances  given  here  we  find 
the  mind  producing  not  so  much  mimicries 
of  disease  and  death  as  actual  lesions  and 
death  itself.  That  is  to  say,  the  power  of 
the  mind  over  the  body  goes  far  beyond 
the  mere  production  of  mimicries,  however 
perfect  these  may  be  in  their  way.  In  these 
we  admit  there  is  no  real  local  lesion,  but 
only  the  unconscious  simulation  of  it.  But 
when  we  find  examples  of  inflamed  fingers 
with  evacuation  of  pus — of  bruises  and  ecchy- 
moses,  actual  death,  haematemesis,  and  gan- 
grene— we  feel  the  word  "  neuromimesis  "  has 
become  well-nigh  as  elastic  as  "hysteria"  itself. 
And  yet  it  would  hardly  do  to  put  these  into 
a  separate  class.  They  are  but  extreme  and 
somewhat  rare  examples  of  the  power  of  the 
mind  over  the  body ;  and  the  generic  term 
"  hysteria "  must  at  present   cover  them  all. 

Perhaps  it  might  be  well  now  to  summarise  Symptoms 

,  .    .  .       .  1  •      «  of  hysteria 

the  symptoms  of  hysteria  m  one  list,*  as 
I    have  done  in   the  case   of    neurasthenia. 

*  Some  of  these,  that  are  symptoms  of  emotional 
hysteria,  have  been  given  on  p.  6$. 

6 


82  NERVES    IN   DISORDER 

Hysteria  (using  the  term  broadly)  is  charac- 
terised by  anaesthesias  in  all  parts  of  the 
body,  in  regions,  patches,  sides,  and  limbs — 
by  visual  anaesthesias  resulting  in  narrowed 
fields  of  vision — by  fits  or  paroxysms  with 
or  without  incomplete  loss  of  consciousness 
and  accompanied  by  clonic  and  occasionally 
tonic  spasms,  tremors,  convulsive  movements, 
and  large  contortions,  sometimes  of  extreme 
violence,  with  or  without  cries,  foaming  at 
the  mouth,  clenching  of  hands  and  other 
emotional  signs — by  dysaesthesias  or  pains 
in  any  joint  in  the  body,  often  in  several ; 
in  painful  zones  or  patches  in  the  head,  the 
back,  the  heart,  the  abdomen,  the  coccyx,  the 
breast,  the  mucous  membrane,  the  organs 
of  special  sense,  the  limbs,  and  the  organs  of 
generation — by  paresis  and  paralysis  of  every 
or  any  part  of  the  body  capable  normally 
or  neuro-    of   voluntary   motion — by    contractions   and 

mimesis.  .  /.     ,.     ,  /•     !•     i  i 

wastmg  of  limbs  or  parts  of  limbs — by 
tremors,  continual  and  intermittent — by 
mental  states,  ecstatic,  vague,  demoniac, 
talkative,  taciturn,  etc. — by  dermatoses — by 
urticaria,  hyperaemias  of  skin  and  other 
eruptions — by  haemorrhages  from  organs  and 
under   the   skin   in   all  parts  of  the  body — 


NEURASTHENIA  AND  KEUROMIMESIS     83 

by  stigmata — by  muscular  atrophies  (detected 
in  lower  limbs  by  absence  of  Babinski's  sign, 
extension  of  big  toe  on  tickling  sole  of  foot) — 
by  pyrexias  of  all  sorts — by  paraplegia — by 
hemiplegia — by  tetany — by  incoordination 
of  muscular  movements — by  swellings  and 
tumours  (perfectly  simulated)  of  all  sorts, 
largely  abdominal,  fluctuating,  solid  or  pulsat- 
ing according  to  the  variety,  and  of  all  sizes — 
by  abnormal  gaits  of  all  kinds — by  mutism 
— by  stammering — by  aphonia,  aphasia,  am- 
nesia— by  coughs — by  dyspnoea — by  dys- 
pepsias— by  gastric  spasms  and  gastralgia — 
by  flatulence — by  haematemesis — by  anorexia 
— by  vomiting,  ordinary  and  faecal — by  bor- 
borygmi — by  swollen  joints — by  dysuria, 
polyuria,  anuria,  incontinence,  retention — 
by  floating  kidneys,  also  by  more  or  less 
elaborate  simulation  of  various  diseases,  such 
as  hip  disease,  asthma,  Pott's  disease,  etc. 

I  have  now  given  a  general  picture  of 
neurasthenia  and  of  hysteria,  more  espe- 
cially of  that  phase  which  we  call  neuro- 
mimesis  ;  and  I  may  pass  on  now  to  consider 
the  general  principles  of  mental  therapeutics, 
and  particularly  their  application  to  the  cure 
of  functional  nerve  diseases. 


On  Mental  Therapeutics 


85 


CHAPTER    III 

ON   MENTAL  THERAPEUTICS 

IN  speaking  in  this  chapter  specially  of 
mental  therapeutics,  it  must  not  for  a 
moment  be  imagined  that  these  are  the 
sole  means  of  cure  at  our  disposal  in 
functional  nerve  disease.  We  will  discuss 
later  other  means  by  which  these  sufferers 
can  be  restored  to  health. 

Mental      therapeutics      cannot,     however,  Mental 
be    omitted    in    any     treatment    of     nerve  pemics 
disease,    and    a    knowledge    of   their    great  ^tted. 
value     is     essential     to      every     physician 
who    would    excel    in    the    cure    of    these 
disorders. 

Mental    therapeutics,    though     universally  Seldom 

used,  more  or  less,  are  seldom  spoken  of  or  scientific- 
ally, 
studied   scientifically  by  the  profession ;  and 

are  not  in   much  favour  even  amongst   the 
87 


88  NERVES    IN   DISORDER 

very  men  who  (often  unconsciously)  largely 
use  them. 

It  is,  no  doubt,  the  connection  of  mental 
therapeutics  directly  with  faith-healing,  mental 
science-healing  in  all  its  many  varieties, 
and  hypnotism,  and  indirectly  with  liquid 
electricities,  billionth  dilutions,  and  quack 
remedies  of  all  sorts,  that  has  so  far  deterred 
the  profession  from  examining  its  wonderful 
powers  very  closely. 
The  reason      For  there  can  be  no  doubt  that  the  force 

why. 

of  mind  in  medicine,  not  being  a  regular 
subject  of  scientific  study  in  medical  schools 
in  this  country,  has  often  been  used  by  clever 
and  unscrupulous  men  for  their  own  advantage 
rather  than  that  of  their  patients ;  and  the 
disgust  rightly  felt  by  honest  men  at  such 
practices  is,  no  doubt,  a  strong  reason  why 
the  subject  is  neglected. 

I  feel  quite  sure,  however,  that  all  such 
reasons  will  fall  to  the  ground  when  the  fact 
of  the  unconscious  mind  is  admitted,  clearly 
and  definitely,  by  scientific  men ;  and  once 
its  powers  become  generally  recognised  they 
will  at  last,  after  long  neglect,  be  made  the 
subject  of  serious  study. 

Still  the  prejudice  exists,  to  the  great  loss 


ON   MENTAL  THERAPEUTICS  89 

of  the  profession,  though  I  have  no  doubt 
it  is  gradually  disappearing.* 

There  are   two   mighty   powers   for   good  ^  physician 

^      -^     ^  ^  wields  two 

in  every  physician  worthy  of  his  name — what  forces, 
he  knows  and  what  he  is ;  but,  alas !  as  a 
rule  he  only  values  the  former,  and  places 
all  his  reliance  on  the  hieroglyphics  in  his 
prescriptions.  But  there  is  a  consciousness, 
in  every  actual  or  potential  patient  who  may 
scan  these  lines,  that  there  is  a  something 
about  his  doctor  that  does  him  more  good 
than  the  medicines,  which  indeed  he  does 
not  always  take.  And  the  doctor  he  likes 
is  the  one  he  sends  for,  in  spite  of  the  fact 
that  the  other  doctor  in  the  town  has  a 
greater  scientific  reputation  and  a  longer 
string  of  letters  after  his  name. 

One   of  the   last   words  of  Henry  Gawen  Value  ot 

personality 

button,  my  teacher  01  pathology  at  the 
London  Hospital,  was :  "  Don't  underrate 
the  influence  of  your  own  personality.  Learn 
to  give  confidence  to  your  patients."  A 
presence  is  of  course  felt  in  proportion  to 
its   power.      "  O    lole,   how   did    you    know 

*  On  this  head  see  "The  Force  of  Mind,  or  the 
Mental  Factor  in  Medicine"  (2nd  Edit.),  by  the  author. 
J.  &  A.  Churchill. 


90  NERVES    IN   DISORDER 

Hercules  was  a  god  ?  "  "  Because  I  was  con- 
tent the  moment  my  eyes  fell  on  him — he  con- 
quered whether  he  stood,  or  walked,  or  sat." 

To  constrain  a  feeble  brain  to  be  governed 
by  a  good  and  strong  one  is  not  a  superhuman 
labour  for  one  who  goes  about  it  adroitly. 
The  fno7nent  the  eye  of  the  patient  meets  the 
eye  of  the  physician,  psychological  action^ 
influencing  the  course  of  the  disease,  at  once 
takes  place  through  the  mediu7n  of  the  patient s 
for  good  unconscious  mind.  The  depression  caused  by 
a  doctor's  bad  manners  or  gloomy  looks  may 
be  combated  actively  by  the  patient's  reason, 
but  will  yet  have  a  bad  effect,  malgre  lui,  on 
his  body  through  the  unconscious  mind,  or 
"  instinct."  Just  as  with  our  material  science 
and  physical  skill  we  seek  by  drugs  and 
other  agents  to  influence  the  body  for  good, 
so  invariably  (and,  as  I  have  said,  most  often 
unconsciously)  does  the  physician's  mind 
influence  that  of  the  patient.  The  "  gift  of 
healing "  that  some  men  seem  to  possess 
to  a  marvellous  extent,  so  that  few  sick  can 
leave  their  presence  without  feeling  better, 
is  a  purely  unconscious  psychic  quality,  at 
any  rate  in  its  origin  ;  though,  like  other 
gifts,  it  can  of  course  be  perfected  by  use. 


ON   MENTAL   THERAPEUTICS  91 

Manner   is   much    in    medicine,    and    the  Manner  in 

medicine. 

personal  presence  is  a  power  in  practice,  and 
both  are  worthy  of  a  serious  consideration 
they  seldom  get. 

Continually  the  consulting  physician  is 
brought  face  to  face  with  cures,  aye  and 
diseases  too,  the  cause  of  which  he  cannot 
account  for.  And  is  he  not  often  surprised  to 
find  that  a  continuation  of  the  same  treat- 
ment originated  by  the  local  practitioner  is, 
when  continued  by  his  august  self,  efficacious  ? 
And  is  not  the  local  practitioner  not  only 
surprised  but  disgusted  as  well  to  find  such  is 
the  case? 

And  this  is  often  what  happens  in  func- 
tional diseases,  where  the  patient  is  unusually 
responsive  to  mental  influences. 

Indeed,  it  is  the  mind  and  not  the  drug 
that  is,  as  a  rule,  the  potent  factor  for  cure 
in  nerve  diseases. 

A  malady  induced  by  mental  causes  can  Value  of 

faith  and 

only  be  cured  by  mental  remedies.  A  full  hope. 
recognition  of  the  value  rightly  attaching  to 
the  mental  treatment  of  physical  ailments 
will  improve  the  usefulness  of  the  physician 
and  materially  assist  in  the  recovery  of  his 
patients.     In  disease,  functional   or  organic. 


92 


NERVES    IN  DISORDER 


Great 
power  of 
uncon- 
scious 
mind. 


the  therapeutic  value  of  faith  and  hope, 
though  not  in  our  text-books^  is  often  enough 
to  turn  the  scale  in  favour  of  recovery. 

For,  although  drugs  are  still  administered, 
but  few  medical  men  now  believe  that  they 
are  the  entire  cause  of  the  cure ;  for  very 
gradually  it  is  beginning  to  dawn  upon  us 
that  most  nervous  diseases  at  any  rate  are 
easily  and  naturally  treated  by  mental 
therapeutics,  and  that  the  still  persistent 
efforts  to  cure  them  by  the  stomach  are 
neither  reliable  nor  rational. 

It  ill  becomes,  therefore,  the  medical  man 
who  recognises  in  these  cases  that  it  is  the 
mind  which  cures  to  decry  any  form  of  mental 
treatment,  if  carried  out  with  honesty  for  the 
patient's  good,  however  little  its  process  may 
be  understood  by  him  in  detail.  We  have 
seen  that  the  powers  of  the  unconscious  mind 
over  the  body  are  well-nigh  immeasurable  ; 
and  believing,  as  we  now  do,  that  our  old 
division  into  functional  and  organic  diseases 
is  merely  the  expression  of  our  ignorance, 
and  that  all  diseases,  even  hysterical,  prob- 
ably involve  organic  disturbance  somewhere, 
we  are  prepared  to  believe  that  faith  and 
other  unorthodox  cures,  putting  into  opera- 


ON   MENTAL   THERAPEUTICS  93 

tion  such  a  powerful  agent  as  the  unconscious 
mind,  or,  if  you  prefer  the  formula,  "  the 
forces  of  nature,"  are  not  necessarily  limited  to 
so-called  functional  diseases  at  all. 

There  is  no  doubt  all  this  will  soon  be 
fully  recognised,  and  the  importance  of  util- 
ising the  power  of  psychotherapy  will  be 
everywhere  admitted.  The  result  will  be  that 
attention  will  no  longer  be  exclusively  con- 
centrated upon  physical  phenomena  or  bodily 
symptoms,  but  the  man  as  a  whole  will  be 
more  studied — body,  soul,  and  spirit ;  and  in 
curing  any  one  part  the  powers  of  all  three 
will  be  used  in  aid. 

"  A  day  will  come,"  says  De  Fleury,*  "when  DeFieur/s 
there  shall  arise  an  upright  and  intelligent 
physician,  strong  enough  to  defy  ridicule, 
and  authorised  by  a  noble  life  and  the  merit 
of  his  labours  to  lay  claim  to  the  superior 
dignity  of  a  moralist.  If  he  knows  the 
human  heart  well  he  can  draw  the  sick  of 
soul  to  him,"  "  The  sound  medical  moralist 
might  be  able  to  double  the  amount  of 
voluntary  energy  and  moral  soul  strength 
in  us  all." 

*  De  Fleury,  •'  Medicine  and  Mind,"  Prize  Essay  of 
the  French  Academy,  p.  224. 


94  NERVES    IN    DISORDER 

The  Dr.  A.  Morrison,   President  of  the  ^scu- 

physician's  r-.      .  u 

vestibule,  lapian  Society,  says  *  :  We  often  do  less 
than  half  our  duty  in  not  exploring  the 
mental  life  of  the  patient.  ...  A  good  deal 
has  been  written  on  prolonged  vascular 
tension  due  to  physical  causes.  Is  there  no 
such  state  as  prolonged  mental  tension  due 
to  moral  causes  ?  ...  In  such  cases,  if  the 
physician  is  to  be  of  any  service  to  his  patient, 
it  must  be  by  the  agency  of  mind  on  mind  ; 
and  this  takes  us  out  of  the  vestibule  littered 
with  microscopes,  crucibles,  and  retorts  into 

The  inner    that  inner  chamber — the  holy  of  holies   in 

chamber  of  .  i     .  . 

mental  the  life  of  a  physician  and  his  patients — 
peutics.  where  heart  and  mind  are  laid  bare  to  the 
sympathetic  gaze  of  a  fellow-man,  whose 
discretion  may  be  relied  on,  and  who  may 
from  his  training  in  the  knowledge  of  the 
human  soul  as  well  as  the  human  body  be 
able  to  cure  his  brother  of  a  most  dis- 
turbing factor  in  his  life  beyond  the  reach 
of  the  advanced  therapeutics  of  a  purely 
physical  kind." 

Before  leaving  this   subject   we  may  look 
at  some  mental  qualities  that  are  recognised 
as  curative  agents. 
*  Dr.  A.  Morrison,  The  PractitioTter,  1892,  p.  27. 


ON   MENTAL  THERAPEUTICS  95 

Sir  John  Forbes  gives   as  psychic   powers  Menta 

curative 

of  cure  :    augmented   hope — faith — cheerful-  qualities, 
ness — mental   activity — decreased    anxiety — 
mental  work — new  motives  for  mental  action 
— new    motives    for    physical   life — soothing 
moral  and  religious  principles. 

"  Imagination,"  says  Sir  J.  C.  Browne,*  "  is 
one  of  the  most  effectual  of  psychical  agencies 
by  which  we  may  modify  the  conditions  of 
health  and  disease."  A  disciplined  imagina- 
tion is  one  of  the  most  valued  tools  of  a 
physician. 

A  strong  will  is  a  good  therapeutic  agent 
Mental  therapeutics  may  be  directed  to 
calming  the  mind  in  excitement,  arousing 
feelings  of  joy,  faith,  hope,  and  love,  by 
suggesting  motives  for  exertion,  by  inducing 
regular  mental  work,  especially  composition, 
by  giving  the  most  favourable  prognosis 
possible,  by  diverting  the  thoughts  from  the 
malady. 

Sympathy,  religion,  common  sense,  patience, 
indifference,  neglect,  altruism,  philanthropy, 
ambition,  are  all  at  times  good  mental 
medicines. 

The  doctor  himself,  his  illegible  prescrip- 

*  See  Sir  J.  C.  Browne,  Leeds  Address,  1889. 


96  NERVES    IN   DISORDER 

The  doctor  tion,  his  room,  and  even  his  fee  (if  impressive), 

himself  as  a 

medicine,  are  all  Valuable  therapeutic  agents,  and 
affect  the  mind  unconsciously,  besides  their 
conscious  effects  on  the  stomach  and  pocket. 

Sympathy  is  indeed  a  powerful  drug  in 
the  hands  of  a  skilful  administrator ;  for, 
after  all,  patients  think  much  more  of  the 
doctor  than  his  prescriptions ;  while  he — 
poor  man — as  we  have  already  said,  generally 
thinks  his  pharmacy  all  and  himself  nothing. 

Success  largely  depends  upon  our  striking 
the  keynote  of  the  characters  we  have  to 
deal  with.  "  In  nerve  disease,"  says  Coleridge, 
"  he  is  the  best  physician  who  knows  best 
how  to  inspire  hope." 
the  family  A  wise  doctor  pays  many  visits  that  are 
physician.  ^^^  confined  to  strictly  professional  topics ; 
for  in  them  the  doctor  learns  much,  as  the 
unconscious  mind  displays  itself  before  him. 
Indeed,  it  is  not  too  much  to  say  that  until 
the  doctor  has  seen  his  patients  at  their  ease 
in  their  own  surroundings  he  never  really 
fully  knows  them.  The  stiff  ten  minutes 
in  the  consulting-room  does  not  reveal  much 
of  the  complex  causes  of  a  difficult  case  of 
functional  nerve  disease. 

It  is  thus  that  a  family  physician  in  the 


ON   MENTAL   THERAPEUTICS  97 

first  instance  has  the  greatest  opportunities 
of  mental  treatment.  His  blue  pill  may  be 
useful,  but  his  opportunities  of  social  inter- 
course, his  tact  in  encountering  false  notions 
and  instilling  healthy  ideas,  are  the  most 
powerful  remedial  agents  he  possesses. 

There   are   at    least   four  ways   by  which  Four 

varieties  of 

mental  therapeutics  can  be  applied  to  disease,  mental 

•  /-I       thera- 

1.  By    the    direct    active    power    of   the  peutics. 
unconscious    mind    inherent    in    itself,    and 
generally  called  the  vis  medicatrix  naturcB. 

2.  By  the  unconscious  mind  influenced 
directly  by  surrounding  personalities  or  other 
unconscious  agencies  acting  as  suggestions. 

3.  By  the  unconscious  mind  influenced 
indirectly  by  the  conscious,  which  has  faith 
in  persons,  systems,  places,  etc. 

4.  By  the  unconscious  mind  indirectly 
acted  on  by  the  conscious  by  distinct  effort — 

n  determination  to   get  well — to   shake   off 

Iness,  ignore  pain,  etc. 
I  must  not  enter  on  these  varieties  in  detail 
now,  as  I  shall  have  to  recur  to  them  again  ; 
but  I  may  point  out  that,  broadly  speaking, 
mental  therapeutics  are  divided  into  natural 
and  artificial  ;    the  former  consisting  of  the 

ealing  power  residing  in  the  body  itself  and 


98  NERVES    IN    DISORDER 

The  vis      knowfi  as  the  vis  medicatrix  naturcBy  and  the 

medicatrix 

ttatura.  latter  of  the  various  means  used  by  the 
physician  consciously  or  unconsciously,  that 
reach  the  disease  through  the  n:iind  of  the 
patient. 

With  regard  to  natural  mental  thera- 
peutics, the  first  point  perhaps  to  consider, 
and  one  of  great  interest,  is  what  is  really 
meant  by  the  well-known  expression  vis 
7nedicatrix  natures. 

Is  it  a  It    has    of    course    been     hotly    disputed 

force?  . 

whether  such  a  force  exists  at  all.  Then,  if 
this  be  admitted,  it  has  been  strongly  argued 
that  it  is  not  a  true  force  ;  while,  on  the 
other  hand,  by  a  very  large  majority  it  has 
been  decided  that  it  is,  and  one  moreover 
of  almost  inestimable  value  in  cure.  It 
appears  to  me  that  this  vis  consists  of  the 
natural  power  resident  in  the  unconscious 
mind  to  preserve  the  body  against  its  enemies 
of  all  sorts ;  and,  if  these  should  have 
gained  an  entrance  in  the  shape  of  disease 
or  accident,  to  combat  them  vigorously ; 
largely  by  what  we  call  "  symptoms  of 
disease,"  and  also  by  other  processes.  These 
"natural  powers,"  however,  form,  after  all, 
only  a  part  of  the  mental  factor  in  therapeutic 


ON   MENTAL   THERAPEUTICS  99 

medicine.  Further  powers  can  be  aroused 
and  brought  into  action  by  mental  therapy, 
in  stimulating  the  patient's  own  mind  to 
greater  efforts  in  various  ways  which  we 
shall  consider.  So  that  the  vis  medicatrix 
natures  and  the  energy  aroused  by  mental 
therapeutics  represent  together  the  powers 
of  the  unconscious  mind  in  its  beneficial  rule 
over  the  body.  We  will  adduce  further 
reasons  for  this  view  as  we  proceed. 

Dr.  Mitchell  Bruce  writes   respecting   this  Views 

^  ^  of  Dr. 

agent  *  :    "  We  are  compelled  to  acknowledge  Mitchell 

r  1  -1  .        ,      Bruce. 

a  power  of  natural  recovery  mherent  m  the 
body — a  similar  statement  has  been  made 
by  writers  on  the  principles  of  medicine  in 
all  ages.  .  .  .  The  body  does  possess  a  means 
and  mechanism  for  modifying  or  neutralising 
influences  which  it  cannot  directly  overcome." 

"  I  believe,"  he  continues,!  "  that  a  natural 
power  of  prevention  and  repair  of  disorder 
and  disease  has  as  real  and  as  active  an 
existence  within  us  as  have  the  ordinary 
functions  of  the  organs  themselves." 

The  most,  then,  a  doctor  can  do  is  to  assist  The  vu  is 

the  body  in  making  use  of  this  great  power,  of  the  un- 
conscious 
*  Dr.  Mitchell  Bruce,  Practitioner^  xxxiv.,  p.  241.        °^''*^- 

t  Ibid.f  p.  248. 


lOO  NERVES    IN   DISORDER 

which,  we  may  once  more  repeat,  is  really 
nothing  more  than  the  action  of  the  uncon- 
scious mind.  The  vis  is  a  fine  illustration 
of  the  power  of  the  mental  factor  in  pathology 
if  not  literally  in  medicine.  So  great  indeed 
is  this  natural  power  that  not  the  most  skilled 
combination  of  drugs  is  of  any  avail  without 
its  aid,  while  the  most  haphazard  remedies 
of  the  purest  empiricism  can  accomplish 
marvels  if  backed  by  this  ever-present  force. 
But  for  this  marvellous  power,  a  morbid 
disturbance  once  set  up  would  inevitably 
continue  to  the  point  of  annihilation ;  for 
treatment  addressed  to  the  living  body  is 
absolutely  meaningless  except  as  an  appeal 
to  such  powers  of  resistance  as  a  patient 
possesses.  When  these  powers  of  the  un- 
conscious mind  fail,  as  in  the  closing  scenes 
of  any  fatal  illness,  it  is  idle  to  expect 
anything  from  treatment,  as  of  course  we 
all  know  death  really  is  the  result  of  the 
failure  of  the  vis  medicatrix  naturcB. 
Mental  Mental  therapeutics  are  not  efficacious  in 

thera- 
peutics act  nervous  diseases  only.     We  have  shown  else- 
diseases,      where  *  how  widely  spread  is  their  value  ;  so 

*  See  "  The  Force  of  Mind  "  (2nd  Edition).    J.  &  A. 
Churchill. 


ON   MENTAL  THERAPEUTICS         loi 

that  there  is,  as  a  matter  of  fact,  hardly  a 
disease  where  it  is  not  felt. 

We  may  give  just  one  or  two  instances 
here  of  the  power  of  the  mind  on  the  body 
in  other  than  nervous  diseases. 

Sir  Humphry  Davy,  wishing  to  experi-  Examples, 
ment  with  some  new  preparation  on  a 
paralysed  patient,  put  first  a  thermometer 
under  his  tongue.  The  man,  believing  this 
was  the  new  remedy,  soon  felt  so  much  better 
that  Sir  Humphry  told  him  to  come  the  next 
day ;  and  in  a  few  days,  with  the  thermometer 
applied  for  some  minutes  each  day,  he  was 
well. 

Dr.  Ranieri  Gerbe,  of  Pisa,  cured  401 
out  of  629  cases  of  toothache  by  making  the 
sufferers  crush  a  small  insect  between  their 
fingers,  which  he  represented  was  an  unfailing 
specific. 

A  surgeon  took  into  a  hospital  ward  some 
time  ago  a  little  boy  who  had  kept  his  bed 
for  five  years,  having  hurt  his  spine  in  a  fall. 
He  had  been  all  the  time  totally  paralysed  in 
his  legs,  and  could  not  feel  when  they  were 
touched  or  pinched  ;  nor  could  he  move  them 
in  the  least  degree.  After  careful  examina- 
tion the  surgeon  explained   minutely  to  the 


I02  NERVES    IN   DISORDER 

boy  the  awful  nature  of  the  electric  battery, 
and  told  him  to  prepare  for  its  application 
next  day.  At  the  same  time  he  showed  him 
a  sixpence,  and,  sympathising  with  his  state, 
told  him  that  the  sixpence  should  be  his  if, 
notwithstanding,  he  should  have  improved 
enough  the  next  day  to  walk  leaning  on  and 
pushing  a  chair,  which  would  also  save  the 
need  of  the  battery.  In  two  weeks  the  boy 
was  running  races  in  the  park,  and  his  cure 
was  reported  in  the  Lancet. 

There  are  several  recorded  cases  of  dropsy 
entirely  disappearing  through  fear. 
Anaesthesia      A  young  lady  who  had  taken  ether  three 

without  J  o  J 

anaesthe-     and  a  half  years  before,  on  the  inhaler  being 
tics. 

held  three  inches  away  from  the   face,  and 

retaining  a  faint  odour  of  ether,  went  right 

off,   and   became    unconscious    without    any 

ether  being  used  or  the  inhaler  touching  her 

body. 

Dr.  W.  B.,  in  1862,  having  to  remove  some 

small    tumours   from    the    head    of    a   lady, 

prepared  to  put  her  under  chloroform,  and 

sent   for  the  bottle,  meanwhile   holding   the 

piece  of  flannel  before  her  face.     He  saw,  to 

his   surprise,   she  was    going  off;    and    she 

was  soon  unconscious,  before  the  chloroform 


ON  MENTAL  THERAPEUTICS         103 

arrived.  The  doctor  removed  a  tumour,  and 
the  dry  flannel  being  taken  away  the  patient 
showed  signs  of  returning  consciousness  ;  on 
its  being  replaced  she  again  went  off,  and  the 
operation  was  completed.  After  some  time 
she  awoke,  having  been  completely  uncon- 
scious all  the  time. 

Dr.  Dureaud  reports  a  certain  unjustifiable  Sickness 

and    death 

experiment  on  a  hundred  hospital  patients,  from  mind 

action. 

to  whom  sugar-and-water  was  given  ;  and 
it  was  afterwards  pretended  that  it  was  an 
emetic  administered  in  mistake.  No  less 
than  eighty  out  of  the  hundred  became  sick. 

A  gentleman,  led  to  believe  (by  a  lie)  that 
he  had  slept  in  a  bed  where  a  man  had  died 
of  cholera,  developed  through  fear  symptoms 
of  the  disease,  and  died. 

Perhaps  these  cases  will  be  sufficient  to 
indicate  to  the  reader  something  of  the  power 
the  mind  can  exercise  over  the  body,  and  to 
help  him  to  understand  the  great  part  it  must 
play  in  the  cure  of  diseases  of  functional 
nervous  origin,  which  are  so  closely  con- 
nected with  it 


Self-Treatment,  Unconscious  and 
Conscious 


los 


CHAPTER  IV 

SELF-TREATMENT,  UNCONSCIOUS  AND 
CONSCIOUS 


W 


E  have  already   described  something  The 

picture. 

of  the  routine  medical  treatment  of 
nervous  patients  that  until  recently  was  as 
common  as  it  was  mistaken  and  injurious, 
and  we  do  not  think  the  picture  has  been 
overdrawn. 

There  can  be  no  doubt  that  functional 
nerve  diseases  have  not  been  handled  in  an 
intelligent  and  scientific  way. 

A  reason  for  this  at  once  suggests  itself  JDescnp- 
when  one  attends  the  medical  schools  and  ciinique. 
cliniques  at  hospitals,  and  hears  diseases  dis- 
cussed. The  way  in  which  the  medical 
history  of  the  case  is  taken,  the  subjective 
and  objective  symptoms  noted,  the  predis- 
posing and  exciting  causes  discussed,  and 
the  aetiology  settled  ;  the  wonderful  care  in 
107 


io8  NERVES    IN   DISORDER 

putting  all  together,  giving  each  symptom 
its  due  weight,  and  the  diagnosis  which  is 
at  length  arrived  at,  fill  one  with  admiration 
and  awe  at  the  science  and  exactitude  of 
medical  research. 
Treatment       gut    when   we  procecd    to   the    treatment 

lightly  dis-  ^ 

missed.  of  the  casc  we  experience  a  shock  ;  for  the 
treatment  is  the  subject  of  no  such  grave 
consideration,  but  is  probably  dismissed  in  a 
sentence,  and  occasionally  we  do  not  get  even 
this,  the  matter  being  left  altogether  to  the 
discretion  of  the  house-physician. 

The  interest  in  surgery  no  doubt  centres 
round  the  operation,  in  medicine  round  the 
diagnosis  of  the  disease. 

Success  in        It  may  be  asked.  How  is  it  possible  that 

treatment 

largely  due  succcssful  treatment  in  ordinary  diseases  can 

to  the  vis  . 

medicatrix  be  a  Secondary  matter ;  carried  on  often 
on  contradictory  lines,  and  sometimes  being 
merely  expectant — placebos,  in  this  case,  in 
the  shape  of  inoperative  medicines,  stilling 
the  cravings  of  the  hospital  patient's  mind 
and  stomach?  The  answer  is  remarkable. 
It  is,  that  it  is  more  and  more  recognised  (as 
notably  in  a  recent  remarkable  address  by 
Sir  Frederick  Treves  at  Liverpool)  by  the 
physicians  standing  around  the  bed,  that  they 


SELF-TREATMENT  109 

are  in  the  presence  of  another  and  greater 
doctor — Dr.  V.  M.  N.  :  a  doctor  trained  in 
no  human  schools,  but  divinely  gifted  to 
heal  all  varieties  of  disease,  and  to  repair 
every  species  of  injury — the  vz's  medicatrix 
natures — in  other  words,  the  "  Unconscious 
Mind." 

"  Every  thoughtful  practitioner,"  says   Dr.  Dr.  w^ii- 

kinson  on 

Wilkinson,*   "  will    acknowledge    that,  when  the  vis 

medicatrix 

his  therapeutic  reserves  are  exhausted,  by  natura. 
far  the  most  reliable  consultant  is  the  vis 
medicatrix  natures.  To  ignore  the  fact  that 
she  has  already  been  in  charge  of  the  case 
for  days,  when  we  first  approach  with  our 
mixtures  and  tabloids,  is  at  least  a  mistake 
in  medical  ethics." 

This  comparative  negligence,  therefore,  in  Medical 

^  £>    o  »  »  treatment 

the  treatment  of  ordinary  diseases  works  well,  of  mmor 

importance 

because  of  the  force  always  in  operation  for  in  many 

cases. 

good  behind  the  doctor;  who  now  knows 
that  the  fever,  the  cough,  the  sweat,  the  loss 
of  appetite,  are  one  and  all  curative  symptoms 
devised  by  the  patient's  unconscious  mind 
for  his  good.  Much  good  (and  sometimes 
harm)  is  undoubtedly  done  by  drugs,  and 
by  other  forms  of  treatment ;  but  every 
*  Dr.  Wilkinson,  The  Lancet^  1897,  ii.  1518. 


no  NERVES    IN   DISORDER 

really  wise  physician  knows  that  no  cure  is 
ultimately  due  to  the  means  he  uses,  though 
he  doubtless  generally  gets  the  credit.  This 
is  not  always  the  case,  however,  in  the  more 
benighted  country  districts,  where  sometimes 
the  greatest  compliment  paid  by  the  patient 
to  the  doctor  is  when  he  says  with  a  grate- 
ful air  that  his  medicine  has  not  "  done  him 
(the  patient)  any  harm  !  " 
Cureb  g^t  thg  difference  is  great  when  we  come 

much  more  ° 

difficult  in   to  treat  functional   nerve  diseases.     Not  un- 

many  nerve 

<Uaeasea.  frequently  the  practice,  after  the  diagnosis 
is  established,  is  to  dismiss  the  treatment 
still  more  curtly,  and  often  with  hardly-con- 
cealed contempt.  But  look  at  the  disastrous 
results.  In  most  ordinary  diseases  the  vis 
medicatrix  natures  is  in  full  vigour  behind 
the  doctor  ;  and  even  if  his  treatment  be  of 
a  very  passive  order,  the  cure  actively  goes 
on  under  the  guidance  of  the  unconscious 
mind. 

ijecause  In   nervous   diseases   it  is  not  so,  for  the 

the  VIS 

medicatrix  simple    rcason    that,    the     nervous     system 

itself  is       being  exhausted  or  diseased,  the  vts  itself — 

the     unconscious     mind — is     weakened     or 

hindered,  or   even    arrested   in    its    action  ; 

for  the  patient  is  weakened  and  diseased  in 


SELF-TREATMENT  in 

the  centres  of  his  being,  in  the  innermost 
machinery  of  his  life,  and  thus  so  frequently 
remains  uncured. 

The  truth  is  that  nervous  diseases  require 
far  more  careful,  well-devised,  and  elaborately- 
carried-out  treatment  than  any  other  ailment, 
because  here  Dr.  V.  M.  N.  himself  is  ill, 
and  cannot  co-operate,  as  in  other  diseases, 
with  the  physician. 

It  would  appear  that  in  neuromimesis  the 
very  unconscious  power  of  cure  that  we  call 
the  vis  works  in  a  morbid  manner,  and  causes 
disease  instead  of  curing  it,  and  is  itself  the 
origin  of  the  ailment ;  instead  of  being  a  vis 
medicatrix  naturcB  it  is  a  vis  morbus  natures. 
Hence  the  treatment,  to  be  successful,  has 
often  to  be  lengthy,  elaborate,  and  expensive, 
and  people  wonder  that  nerve  diseases  are 
so  hard  to  cure,  having  no  idea  that  it  is 
for  want  of  the  efficient  help  of  Nature's 
doctor. 

What  a  wise  physician  does  in  these  cases  First  step 

IS  to  restore 

is  to  get  the  vis  inedicatrix  natures  as  soon  the  vis  to 

Ml-  activity. 

as  possible  mto  workmg  order,  so  that  it  may 
co-operate  in  the  further  treatment  of  the 
disease. 

But  this   requires   a  knowledge  of  mental 


112  NERVES   IN   DISORDER 

therapeutics,  for  to  minister  to  a  mind 
diseased,  conscious  or  unconscious,  mental 
remedies  must  be  used,  and  these  are  by 
no  means  in  favour  in  the  profession,  nor 
are  they  very  skilled  in  their  use. 
Quacks  Ouacks  Hve  and  thrive  on  the   misuse   of 

thrive  on  =* 

functional    them,  and  hundreds  of  patients  who    might 

nerve  *■  " 

diseases,  well  be  curcd  by  physicians  are  driven  to 
them,  because  the  former  have  never  seriously 
studied  the  special  therapeutics  of  functional 
nerve  diseases, 
^cks  stiu  Lately  in  the  British  Medical  Journal 
flourish.  ^  writer  has  been  denouncing  quacks, 
and  pointing  out  many  of  their  questionable 
practices.  But  the  writer  does  not  say  why 
they  still  flourish  ;  nor  why,  in  this  educated 
period,  they  are  as  numerous,  or  more  so,  as 
in  the  dark  ages,  and  can  still  undoubtedly 
produce  large  numbers  of  genuine  cures. 
If  the  common  sense  of  the  public  has  not 
yet  enabled  this  enlightened  body  to  suffi- 
ciently distinguish  between  the  value  of  the 
regular  orthodox  practitioner  and  the 
opposing  army  of  quacks,  special  "  pathists  " 
and  faddists  of  all  sorts,  whether  counts  or 
commoners,  it  is  to  be  feared  that  there  is 
rather  a  poor  prospect  of  their   ever  doing 


SELF-TREATMENT  113 

SO  as  long  as  matters  are  as  they  are.  The 
public,  curiously  enough,  set  a  far  higher 
value  on  a  "cure"  than  the  trained  pro- 
fessional man.  With  him,  as  we  have  said, 
interest  centres  in  the  diagnosis  of  the  disease, 
and  it  is  to  this  point  that  the  most  careful 
teaching  and  training  are  directed.  We  do 
not  say  that  to  most  it  is  the  "  end  "  ;  but 
it  is  certainly  a  very  prominent  "  means " 
indeed  to   it,  and  necessarily  so. 

The  public,  and  with  them  the  quacks.  The  public 
care  little  about  the  diagnosis,  for  which  for  cures. 
they  have  neither  learning  nor  interest ; 
what  they  do  look  for  is  the  cure,  which, 
alas !  is  often  effected  without  any  diagnosis 
at  all,  though  not  without  grave  risk  to  the 
patient  for  want  of  it.  As  long,  therefore, 
as  quacks  cure  diseases,  so  long  will  the 
public  employ  them ;  and  no  amount  of 
Carlylean  quotations  as  to  the  number  of 
fools  in  the  world,  or  contemptuous  classi- 
fication of  the  cured  diseases  as  imaginative, 
will  alter  their  attitude. 

The  subject  of  mental  therapeutics  is  still  ^^"^^^ 
ignored  in  medical  works  generally.     In  our  peutics 

°  o  ^  Ignored, 

physiologies  no  reference  is  now  made  to 
the  central  controlling  power  that  rules  the 


114  NERVES    IN    DISORDER 

body   for   its   good,   and   the   power  of    the 
mind  over  the  body  is  seldom  spoken  of. 

Systems  of  medicine,  however  large  and 
modern,  display  the  same  character  as  the 
physiologies.  A  rather  old  book,  Pereira's 
"  Materia  Medica,"  devotes  three  pages  out 
of  2,360  to  "psychic  therapeutics."  Dr. 
Shoemaker,  of  Philadelphia,  in  his  "  System 
of  Medicine,"  spares  one  page  out  of  about 
1,200  ;  but  most  of  the  others,  including  far 
larger  works,  devote  none. 

Every  possible,  and  even  impossible,  aid 
to  therapeutics  is  gravely  discussed  at 
length ;  including  the  values  of  obscure 
organic  extracts ;  of  special  artificial  forms 
of  exercise  under  innumerable  names ;  of 
every  variety  of  light,  heat,  and  Rontgen 
ray ;  of  German  synthetic  compounds  with 
barbarous  polysyllabic  titles ;  of  patent 
foods,  and  of  systems  innumerable ;  while 
not  one  line  is  devoted  to  the  value  of  the 
mental  factor  in  general  therapeutics. 
Good  treat-  No  doubt  many  physicians  treat  nervous 
mostly  diseases  of  functional  origin  wisely  and  well, 
empincai.  ^^^  what  we  contend  for  is  that  the  know- 
ledge they  display  was  taught  at  no  school, 
was  learned  from  no   book,  but  is   intuitive 


SELF-TREATMENT  115 

and  empirical ;  they  owe  nothing  in  this  to 
their  costly  training,  but  everything  to  them- 
selves. This  is  not  as  it  should  be.  The 
power  of  mental  therapeutics  and  the  general 
treatment  of  functional  nerve  diseases  should 
be  the  subject  of  careful,  special,  and 
scientific  teaching  in  every  medical   school ;  Scientific 

tc3.chiri'^  IS 

and  if  I  may  judge  by  the  many  encouraging  increasing, 
letters  that  reach  me  from  various  sources, 
will  become  so  in  many  hospitals  before  long. 
We  might  pursue  the  subject  of  maltreat- 
ment or  want  of  treatment  further  in  detail, 
and  describe  thedisastrous  results  of  neglected 
cases  ;  but  the  task  is  an  invidious  one,  for 
it  is  far  better  to  consider  one's  own  faults 
than  to  dwell  on  the  mistakes  of  others. 


We  will  therefore  turn  now  to  the  question  Cure  of 

disease  by 

of  the  cure  of  these  diseases,  confining  our-  the  patient, 
selves    in   this   chapter  to   considering   what 
patients  can  do  for  themselves,  either  entirely 
apart  from   the  doctor,  or  with  his   aid   and 
supervision. 

There  can  be  no  doubt   that  few  patients  a  patient 
are  aware  how  much  they  can  do  for  them-  much  in  an 
selves  when  suffering  from  incipient  functional  ^^^^  ^^^' 
nervous   disease.     Before    it   ever  gets   to   a 


Ii6  NERVES    IN   DISORDER 

medical  stage,  when  professional  help  must  be 

called  in,  they  can  arrest  it  and  regain  their 

health  by  their  own  treatment  in  many  cases. 

When  a  man  or  a  woman    first  finds  out 

that   his  nerves  are  not   in   good    condition, 

instead  of  indulging  in  fancies  and  imagining 

he   may  be  losing  his  reason,  or   that  he  is 

Remove      "  Only  pretending,"  he  should  seek  out  the  two 

fer^^^p^s-  causes  that  brought  him  to  his  present  state 

«ibie.  — ^Yie  predisposing  and  the  exciting  causes. 

It    is   generally    the    case    that   the    former 

is  difficult  or  impossible  to  alter,  the  latter 

easy. 

Predisposing  causes  are  mainly  questions 
of  heredity,  which  obviously  cannot  be  cured, 
but  must  be  endured.  Or  perhaps  they  may 
be  the  general  surroundings  or  mode  of  life, 
or  some  sort  of  past  shock  or  trouble. 

The  exciting  cause,  on  the  contrary,  is 
generally  some  present  incident  or  pressure 
or  trouble  or  condition  that  can  more  easily 
be  altered,  avoided,  or  removed.  There  may 
be  contributing  causes  of  a  physical  nature — 
there  very  frequently  are.  The  diet  may 
be  wrong,  the  sleep  may  be  insufficient, 
the  climate  may  be  at  fault,  the  work  or 
occupation   too   severe.      In   all   these  cases 


SELF-TREATMENT  117 

the  first  step,  obviously,  is  to  remove  any 
possible  cause  that  may  have  produced  or 
contributed  to  the  illness. 

A  change  of  diet,  of  life,  of  surroundings,  Patient  can 

change  the 

of  climate,  of  work,  of  companions,  or  ofenviron- 
habits  may  be  necessary ;  and  these,  at  any 
rate,  are  within  the  patient's  power  to  make, 
though  it  frequently  happens  that  the  trouble 
and  responsibility  involved  make  him  far 
happier  if  he  first  saddles  a  doctor  with  the 
responsibility  of  his  deeds,  by  acting  on 
"medical  advice." 

Many  and  many  a  man  'comes  to  a  doctor,  One  reason 

for  consult- 
not  because  he  does  not  know  what  causes  ing  a 

doctor. 

his  illness  and  how  to  remove  it,  but  because 
he  lacks  the  courage  to  take  the  necessary 
steps,  and  only  when  strengthened  by  the 
doctor's  fiat  has  the  resolution  to  act. 

We  need  not  enter  into  particulars  of 
such  actions,  which  necessarily  vary  with 
each  individual  case :  suffice  it  to  say  that 
the  patient  can  do  much  to  cure  himself 
in  the  early  stages  of  "  nerves "  by  taking 
common- sense  measures  to  remove  the  causes 
of  his  disease,  without  taking  any  drugs 
whatever.  One  of  the  first  points  to  note, 
when  the  nervous  system  is  on  the  verge  of 


Ii8  NERVES    IN    DISORDER 

No  loss  of  becoming  unbalanced,  is  to  retain  by  every 
control.  possible  means  one's  self-control.  For  this 
reason  tears  are  often  dangerous  then,  and 
should  be  restrained,  except  in  some  extreme 
cases  where  they  afford  necessary  relief.  If 
a  state  of  nerves  or  nervousness  comes  on, 
anything  and  everything  should  be  done  to 
avoid  a  breakdown,  which  always  paves  the 
way  and  makes  it  easier  for  a  second — ^just 
as  a  horse  which  has  run  away  once  wants 
to  run  away  again. 

To  this  end  a  brisk  walk  in  the  open  air 
is  beneficial ;  or,  if  this  be  not  possible  or 
prudent,  a  very  good  plan  is  to  undress 
completely  on  the  spot,  take  a  warm  bath, 
followed  with  brisk  rubbing,  and  then  dress 
again,  preferably  in  fresh  things. 
Patient  can      But   the   patient   can   do   more.     He   can 

often  treat     ,    -    .     ,  i     i  • 

the  disease,  definitely  attack  the  nerve  symptoms,  and  this 
in  two  ways :  either  by  counter-irritants, 
thus  distracting  attention  from  them  by  con- 
centrating it  elsewhere  ;  or  he  can  directly 
face  them  and  overcome  them  by  exerting 
the  force  of  mind  over  the  body — by  will, 
by  the  formation  of  habits,  and  in  other 
ways. 

The   power  of   the   mind   over   the   body 


SELF-TREATMENT  119 

has   limits,  but   they  have    never  yet  been  By  exerting 
ascertained.     What  a  patient  can  do  to  cure  powers. 
himself,  the  forces  he  can  set  in  action,  are 
as  yet  unknown.     We  are  inclined  to  believe 
they  are  far  greater  than  most  imagine,  and 
will   undoubtedly  be   used    more   and   more. 
A  strong  will  is   a   good   therapeutic  agent. 
Mental    therapeutics    may    be    directed    by 
the  patient  himself  to  calming  the  mind  in 
excitement,   arousing   feelings   of  joy,  hope, 
faith,  and   love ;   by   suggesting  motives  for 
exertion,   by  ordinary  regular   mental  work, 
especially    composition;    by    giving    oneself EspedaUy 
the   most  favourable   life   suited  to  cure  the  diseases. 
disease,  by   diverting  the  thoughts  from  the 
malady. 

We  may  give  two  illustrations  of  the  self- 
cure  of  patients  effected  by  their  own  minds, 
mainly,  if  not  entirely. 

In  1837,  Pastor  Chiniquy,  then  a  Roman  pastor 
Catholic  priest,  got  severe  typhoid  fever  in  and"  '^^^ 
Canada,  and  four  physicians  told  his  bishop  %^^°^^ 
there  was  no  hope  of  his  recovery.     On  the 
thirteenth  day  they  said  he  had  only  a  few 
minutes  to  live,  and  his  pulse  could  not   be 
felt.     He  then  in  a  vision  saw  his  favourite 
ittint,  St.   Anne,  to  whom  Jie  cried  for  cure 


I20  NERVES    IN   DISORDER 

with  every  power  of  his  soul,  and  he  heard 
her  say  "  You  will  be  cured."  He  recovered, 
and  Quebec  rang  with  the  miracle. 

He  was  examined  by  two  Catholic  and 
two  Protestant  doctors.  Dr.  Douglas,  a 
Protestant,  showed  Chiniquy  his  recovery  was 
due  to  his  being  a  man  of  remarkably  strong 
will,  and  determination  to  resist  death  :  that 
the  will  had  a  real  power  over  the  body,  and 
his  strong  will  had  conquered.  Chiniquy 
listened,  but  preferred  his  saint,  and  had  a 
votive  picture  painted  of  her  for  ;^5o.  A 
priest  who  saw  it  then  told  Chiniquy  the  cure 
was  no  miracle,  and  that  most  of  the  crutches 
hanging  round  the  church  were  left  by 
impostors,  and  the  rest  by  those  cured  by  the 
power  of  the  mind  over  the  body. 

Till  1858  that  picture,  representing  the 
saint  telling  Chiniquy  he  would  be  cured,  was 
Chiniquy's  in  the  church.  In  that  year  he  again  got 
typhoid  fever  in  Chicago,  and  once  more  was 
given  up  as  dying.  But  this  time  he  did 
not  cry  to  the  saint,  but  made  a  determina- 
tion to  get  better,  and  soon  felt  life  returning. 
He  then  saw  the  saints  had  no  part  in  his 
previous  cure,  and  took  his  picture  down  and 
burnt  it. 


second 


SELF-TREATMENT  121 

The  above,  even  if  not  accurate  in  all 
details,  contains  a  good  illustration  of  the 
power  a  patient  has  over  his  disease.  I  will 
give  one  more,  from  personal  experience. 

I  had  some  time  ago  a  favourite  nurse,  who  ^"'^  °l . 

°  typhoid  in 

always  had  a  superstition  she  would  die  of  a  nurse. 
typhoid  fever.  She  contracted  it  at  length 
when  nursing  a  bad  case  of  mine,  and  lay 
in  a  county  hospital  apparently  dying,  in 
the  third  week  of  the  disease,  in  a  low  typhoid 
condition,  and  with  every  appearance  of 
collapse,  but  with  the  mind  clear. 

I  went  in  to  see  her  for  the  first  time, 
and  found  her  much  depressed. 

She  told  me  she  was  about  to  die. 

"  Certainly,"  I  said. 

She  looked  up  and  replied,  "Yes,  but  I 
mean  it ;    I  always  said  I  should." 

"  Then  of  course  you  will,"  I  retorted. 

She  stared,  and  said,  "  Don't  you  mind  ?  " 

I  said,  "What  is  the  use  of  minding?  You 
are  going  to  die  if  you  say  so." 

"  My  saying  so  doesn't  make  me  die," 
she  answered. 

"  Perhaps  it  does,"  I  replied,  "  for  if  you 
said  you  wouldn't  die,  you  would  probably 
live." 


122  NERVES    IN   DISORDER 

Thewii  I  saw,   as  far  as    I    could   judge,  she  had 

thrown  into  j       o   ' 

the  scale,  reached  that  point  when  the  throwing  of 
the  will  into  either  balance  would  determine 
the  issue. 

"  Do  you  mean  that  ?  "   she  said. 

*'  Yes,  I  do,"  I  replied,  "  and,  what  is  more, 
unless  you  say  so,  I  won't  come  and  see  you 
again.  It  is  now  11.30,  and  if  now,  at  this 
hour  of  the  morning,  you  turn  your  mind 
the  other  way,  and  determine  to  live  and  not 
die,  I'll  do  all  I  can  to  help  you.  You  shall 
have  another  nurse,  and  I'll  get  the  doctor 
to  let  you  have  a  little  champagne.  But  this 
resolve  must  come  from  you." 

She  looked  me  hard  in  the  face,  and,  seeing 
I  meant  it,  and  believing  me  in  her  heart, 
she  said  in  deepest  earnestness,  "  I  will,"  and 
from  that  hour  she  steadily  gained  strength, 
and  soon  got  well. 

I  firmly  believe  that  interview  saved  her 
life,  and  that  from  that  moment  the  curative 
action  of  the  vz's  niedicatrix  naturce — the  un- 
conscious mind — was  immensely  strengthened 
and  quickened  by  the  force  of  the  woman's 
conscious  will. 
¥*^y  To   some  this   may  seem   strange,  but  to 

cases.         those  who   have  studied   the  subject   many 


SELF-TREATMENT  123 

similar  instances  will  come  to  mind  ;  for  in 
one  way  or  another  such  cases  occur  every 
day,  though  they  most  often  pass  unnoticed. 

The  cultivation  of  the  will  greatly  increases 
its  power.  But  the  mere' determination,  how- 
ever strong,  to  be  freed  from  the  nervous 
sufferings  does  not  always  drive  them  away  ; 
we  have  a  far  greater  power  to  effect  this, 
and  that  is  the  power  of  auto-suggestion. 

I  do  not  say  for  a  moment  this  is  as  Auto- 
efficacious  as  enlightened  medical  treatment, 
but  it  has  these  advantages  :  that  it  costs 
nothing,  that  it  can  be  applied  at  home,  and 
that  it  requires  no  drugs  nor  apparatus. 
This  auto-suggestion  differs  entirely  from 
hypnotism,  in  that  there  is  no  hypnotist,  and  Without 

J  sr  ^  J  r  '  hypnotism. 

the  patient  has  not  to  go  to  sleep,  but  is 
in  full  possession  of  his  faculties.  What  he 
has  to  do  is  carefully  and  systematically  to 
saturate  his  brain  by  suggestion  with  what 
he  wishes  himself  to  be  or  to  become.  This 
can  be  done  by  speech,  by  thought,  by  sight, 
and  by  hearing.  Here  are  four  brain-paths, 
all  of  which  tend  to  set  the  unconscious 
mind — the  vis — to  work  at  the  process  of 
cure. 

The  point  to  see  in  this  method  of  cure 


124  NERVES    IN   DISORDER 

is  that  after  all  the  condition  of  the  patient 
is  often  so  nicely  balanced  that  a  little  may 
turn  the  scale  the  right  way. 
Dominant        Liebcault,  Vofft,  and  Bernheim  point  out  in 

ideas  °  '■ 

determine   various  ways  that  great  results  are  frequently 

conduct. 

determined  by  emotion-ideas  or  "  dominants 
themselves  insignificant.  A  man  outside  a 
baker's  shop  may  be  just  balanced  between 
stealing  or  not  Hunger  prompts  the  one 
way,  principle  the  other.  Now,  if  an  emotion- 
idea  is  presented  to  his  mind  of  his  starving 
family  at  home,  he  takes  a  loaf  and  becomes 
a  thief  If,  on  the  other  hand,  a  vision  of 
prison  Or  the  verse  "  Thou  shalt  not  steal " 
rises  forcibly  in  his  brain,  he  walks  away. 
In  the  same  way  in  many  nerve  affections 
a  comparatively  slight  self-suggestion  will 
enable  us  to  do  what  we  otherwise  could 
not,  and  so  overcome  some  nervous  dread. 
iiiuste-ation      For    instance,    a    person    with    some    un- 

ofauto-  .  . 

suggestion  reasonable  fear  that  is  poisonmg  his  life 
may — besides  removing  any  contributing 
cause,  besides  combating  it  with  his  will- 
power— actively  employ  auto-suggestion  by 
bringing  his  reason  to  bear  on  it ;  and  show 
its  folly  to  himself  by  saying  aloud  at  the 
most  impressionable  time,  when  just  waking 


SELF-TREATMENT  125 

or  falling  asleep,  how  unreasonable  the  fear 
is,  by  thinking  similar  thoughts,  by  seeing  in 
print  the  folly  of  his  fears  described,  and  by 
hearing  others  say  the  same.  This  may 
not  cure  the  trouble  in  all  instances,  but 
it  will  in  slight  cases  be  found  effectual,  and 
is  at  any  rate  innocuous. 

Besides  this,  some  definite  domestic  treat-  Domestic 

,  ,     ,       .  11.  .         treatment. 

ment  may  be  added.  As  a  prophylaxis  agamst 
incipient  neurasthenia  we  may  mention  for 
women  a  day's  complete  rest  in  bed  ;  and 
for  men  a  week-end  away  from  home,  at  a 
good  inn  in  the  country  or  at  the  seaside. 

For  incipient  nervous  dreads  or  ideas,  some- 
times hard  enforced  work,  that  engrosses  the  * 
mind  as  well  as  tires  the  body,  is  an  admirable 
curative.  Of  course  in  these  and  many  other 
methods  disappointment  may  result,  and 
time  may  be  lost,  and  in  all  of  them  the 
counsel  of  a  wise  physician  to  direct  in  the 
details  of  auto-suggestion,  etc.,  is  a  great  help  ; 
but  in  the  absence  of  this  we  are  sure  that 
a  great  deal  can  thus  be  done  by  the  patient 
himself  without  medical  advice. 

One  great  point  is  for  the  patient  thoroughly  Nerve 
to   disabuse  his  mind  of  the  idea  that  these  seldom  un- 

...  -11  -1  binge  the 

nervous  disorders   are  a  sign  that  the  mind  mind. 


126  NERVES   IN   DISORDER 

is  going.  This  is  often  the  worst  torture 
of  all  to  bear ;  indeed,  so  bad  is  it,  that 
sometimes  when  it  is  removed  all  the  other 
symptoms  disappear  as  if  by  magic. 

Let  the  sufferer,  then,  in  the  earlier  stages 
of  nerve  trouble,  seek  to  remove  the  cause, 
to  combat  the  symptoms  by  his  will,  by 
suggestion,  and  by  habits  and  occupations 
calculated  to  cure  them. 

If  all  fails,  perhaps  the  next  chapter  will 
show  what  the  physician  may  further  do 
for  him. 


Medical  Treatment  of  Functional 
Nerve  Diseases 


127 


CHAPTER  V 

MEDICAL  TREATMENT  OF  FUNCTIONAL 
NERVE   DISEASES 


I 


T  may  be  best,  in  outlining  the  treatment  Some  con- 

•         1  !•  11  T      1  ditions  of 

of  functional  nerve  diseases  by  the  medical  success 

man,  to  first  point  out  some  conditions   on 

which     success     depends     in     the     general 

management   of  these    cases,    and    then    to 

loUow  with    a   few   special    remarks    as    to 

the   treatment    of  neurasthenia    and    neuro- 

mimesis. 

Experience    in    medicine    has    mostly   to 

be  bought,   and   often   dearly ;    and    if    the 

following   points   have   any  value   to   others 

in    handling    these    difficult    diseases,    it    is 

because     they    are    the    outcome    of    many 

painful     lessons    and     failures     in     working 

amongst  these  cases  for  many  years. 

One    may  say  here    at    the   outset   that,  J°  func- 
tional nerve 

though  in  our  modern  textbooks  neurasthenia  diseases. 

129  9 


I30  NERVES    IN    DISORDER 

and  hysteria  are  rightly  treated  under  distinct 
heads,  as  we  are  now  speaking  of  treatment 
generally,  we  will  use  the  former  term  in 
a  broad  sense  to  embrace  all  functional 
nerve  cases. 

To  make  the  hints  given  as  clear  and  as 
useful  as  possible,  it  may  be  well  to  crystal- 
lise them  around  four  centres.  First,  the 
physician ;  secondly,  the  patient ;  thirdly, 
methods  of  treatment ;  fourthly,  various 
details.  In  other  words — personality,  diag- 
nosis, treatment,  and  details. 

The  first  point  one  would  make  in  con- 
nection with  the  physician  (in  the  teeth 
of  much  that  has  been  written,  and  against 
the  practice  of  some  noted  neuropaths)  is 
that  one  of  the  chief  conditions  of  success 
is  sympathy,  and  one  of  the  chief  causes  of 
failure  is  the  want  of  it. 
Sympathy        J   ^Jq   not  Say  it  need  be  always,  or  even 

in  the  "^ 

physician,  frequently,  shown ;  but,  believing  as  I  do 
in  the  subconscious  mind,  and  the  quick 
unconscious  relation  of  one  mind  to  another 
when  in  harmony,  I  have  no  doubt  what- 
ever that  real  sympathy  is  always  felt 
wherever  it  exists  in  the  physician  for 
the   sufferer,   though  it   be   not   shown  ;   the 


MEDICAL   TREATMENT  131 

proof  being  that  it  gives  a  confidence  in 
his  skill,  and  a  restful  feeling  of  being 
understood — that  is  no  mean  factor  in  the 
cure  of  every  disease,  but  especially  so  in 
those  of  which  we  now  write.  Concerning 
these,  indeed,  we  are  certain  that  any 
doctor  who  does  not  inspire  his  patients 
with  this  confidence  will  have  more  failures 
than  cures. 

To  feel  this  sympathy  one  must  believe 
in  the  reality  of  the  sufferings  of  the  patient, 
and  dismiss  absolutely  the  blight  of  sus- 
pected malingering.  One  must  grasp  the 
truth  of  the  brilliant  dictum  of  Sir  James 
Paget,  who  declared  that  while  the  patient 
says  she  "  cannot "  and  the  nurse  that  she 
"  will  not,"  the  truth  is  that  she  "  cannot 
will." 

Let    us    remember,    what   has    been    said  Pain  is  a 

mental 

already,  that  a  disease  of  the  imagination  fact. 
is  not  an  imaginary  disease,  and  that  pain, 
in  its  last  analysis,  is  a  mental  rather  than 
a  physical  fact,  for  its  reality  does  not  in 
the  least  depend  upon  its  resting  on  any 
definite  physical  basis. 

To  tell  neurasthenics  or  hysterics  that 
there    is    nothing    the     matter    with    them, 


132  NERVES    IN    DISORDER 

because  no  clear  physical  basis  can  be  dis- 
covered for  the  symptoms  complained  of 
— unless  done  deliberately,  in  exceptional 
cases,  for  a  definite  purpose — is  to  confess 
oneself  unfit  to  deal  with  functional  nerve 
diseases. 

As  slowly,  very  slowly,  the  enormous 
powers  of  the  subconscious  mind  over  the 
body  are  beginning  to  be  dimly  perceived, 
such  crude  and  false  statements  are  be- 
coming rarer ;  but  they  are  still  common 
enough  amongst  those  whose  opinions  are 
founded  solely  upon  physical  diagnosis. 
Patience  The  next  qualification  in  the  physician 
physician,  is  patience,  and  this,  I  think,  is  different 
from  mere  endurance,  and  really  depends 
upon  the  first  quality — sympathy.  It  is  only 
those  who  know  the  tortures  undergone  by 
functional  nerve  sufferers — the  pariahs  and 
outcasts  amongst  patients  and  doctors — and 
who  feel  for  their  sufferings,  that  can 
possibly  put  up  with  the  trying  nature  of 
the  sufferer  and  his  multifarious  and  often 
apparently  incurable  troubles.  As  long  as 
a  doctor  has  any  doubt  as  to  the  definite 
and  real  character  of  the  disease,  as  long 
as  the  bona  fides  of  the  patient  is  a  matter 


MEDICAL   TREATMENT  133 

of  question,   so   long   is   it  very  difficult  for 
him  not  to  be  defective  in  patience. 

The  lack  of  this  virtue  in  doctors  fills 
our  holiday  and  health  resorts  abroad 
with  patients  sent  there  because  the  doctor 
could  not  stand  the  strain  at  home,  and, 
recognising  his  resulting  impotence,  ordered 
travel  as  the  best  way  out. 

Allied  to  patience  is  perseverance.  The  Persever- 
despondency  of  the  patient,  the  scepticism  physician, 
of  relations,  the  continued  and  heavy  expense 
to  them,  over  which  the  physician  has  little 
control,  and  the  want  of  any  signs  of  im- 
provement, it  may  be  for  weeks,  render  this 
virtue  also  most  difficult  to  practise.  And 
yet  for  want  of  it  how  many  patients  go 
unrelieved,  how  many  incipient  cures  are 
nipped  in  the  bud,  and  how  many  success- 
ful methods  are  prematurely  abandoned  as 
failures !  If  we  have  sound  grounds  for 
believing  our  treatment  is  rational,  if  we 
have  seen  successful  results  from  it  in 
previous  cases,  and,  above  all,  if  there  is  the 
least  glimmer  of  improvement,  let  us  per- 
severe on  and  on.  There  is  no  space  here 
to  adduce  cases  in  proof  of  this,  but  I  have 
one  in  mind  that,  after  defying  every  doctor 


134  NERVES    IN    DISORDER 

and  every  variety  of  Weir- Mitchell  and 
similar  "  cures,"  was  at  last  successfully  re- 
stored to  health  mainly  by  being  persistently 
kept  in  bed  for  five  months  on  end,  by  a 
doctor  who  would  not  be  beaten. 
Firmness         Closely  connected,  again,  with   this  is  the 

in  the  .  .   _  /-.      . 

rAysician.  question  o\  firmness.  Curious  as  it  may  seem, 
it  is  easy  to  be  too  firm,  and  still  easier  not 
to  be  firm  enough.  The  path  of  success 
here  undoubtedly  lies  in  the  golden  mean 
between  the  two.  Be  inflexible  as  cast  iron 
in  things  essential,  flexible  as  steel  in  all 
matters  non-essential  ;  and  never,  as  is  so 
common,  inflexible  from  mere  doggedness, 
but  always  intelligently.  This  gives  con- 
fidence, brings  success,  and  avoids  friction 
with  patients  and  friends.  No  patient  really 
"  believes  in  "  a  doctor  who  absolutely  lacks 
it ;  it  is  the  quality  above  all  others  that 
inspires  respect. 

Tact  in  the      Perhaps  this  question  really  depends  upon 

physician.  *■  *■  .  . 

the  next  great  virtue,  without  which  neur- 
asthenics cannot  be  successfully  treated,  and 
that  is  tact.  Tact  is  the  unconscious  mental 
touch,  the  tactus  eruditus,  by  which  one  mind 
feels  another;  and  just  as  a  physician's 
physical  tactile  sense  is  educated  to  discern 


MEDICAL  TREATMENT  135 

much  by  mere  touch,  so  can  mental  tact 
help  the  nerve  doctor  immensely  along  his 
difficult  path. 

Take,  for  instance,  the  one  question  of  Should  a 
whether  to  make  light  of  any  particular  be  ignored 
symptom  or  to  treat  it  quite  seriously.  The 
answer  does  not  in  a  neurasthenic  in  the  least 
depend,  as  the  doctor  may  naturally  think, 
upon  the  amount  of  obvious  physical  basis 
upon  which  that  symptom  may  rest,  but 
on  the  effect  on  the  patient's  mind  of  your 
levity  or  gravity ;  and  to  ascertain  this  effect 
beforehand  is  the  highest  outcome  of  tact. 

For  it  must  ever  be  recognised,  and  may  The  nature 
here  be  categorically  asserted,  that  amongst  mimesis, 
functional  nerve  diseases  hysteria  or  neuro- 
mimesis  at  any  rate  is  distinctly  a  disease 
of  the  subconscious  mind,  of  unconscious 
suggestion  ;  and  it  is  in  this  very  fact  of 
its  unconscious  nature  that  it  differs  from 
all  forms  of  malingering,  which  always  imply 
conscious  fraud.  Whatever  diseased  physical 
conditions  may  therefore  coexist  require 
treatment,  but  the  mental  condition  is  un- 
doubtedly the  more  important,  and  is  the 
one  which  in  every  case  requires  the  greatest 
judgment  and   tact.     Most   medical   men,   I 


136 


NERVES    IN   DISORDER 


Difficulty 
of  treating 
these 
diseases. 


Import- 
ance of 
honesty. 


Attention 
to  details. 


believe,  are  inclined  to  glorify  their  own 
particular  branch  of  the  profession  ;  but  one 
cannot  but  see  that,  in  pursuing  to  its  recesses 
and  in  curing  diseases  produced  by  such  a 
mysterious  agent  as  the  unconscious  mind, 
one  has  to  employ  power  and  means  of  a 
very  different  nature  from  the  comparatively 
simple  and  straightforward  processes  of  purely 
physical  medicine  and  surgery. 

I  may  perhaps  just  say  a  word  on  the 
value  of  honesty  with  these  patients  ;  for  it 
is  a  word  by  no  means  limited  to  its  ordinary 
sordid  interpretation.  I  mean  absolute 
honesty  in  considering  and  acting  solely 
in  the  patient's  interests,  as  distinguished, 
not  from  the  doctor's,  but  from  the  parents, 
friends,  and  relatives,  and  others  whose 
counsels  and  pleadings  so  often  turn  aside 
the  otherwise  sound  judgment  of  the 
physician. 

Lastly,  success  depends  upon  a  power 
of  attention  to  details  that  is  not  always 
found  in  minds  broad  enough  to  grasp  the 
case  as  a  whole.  Minds,  as  has  been  pointed 
out,  are  generally  characterised  by  observation 
or  imagination.  The  former  quality  gives 
accuracy    in    details,   the   latter    broad   and 


MEDICAL  TREATMENT  137 

wide  views.  The  combination  is  rare,  and 
those  who  possess  it  are  generally  masters 
of  their  profession,  and  in  nerve  diseases  this 
union  is  of  especial  value.  The  doctor  who 
knows  and  sees  that  his  patient  is  not 
disturbed  at  night  after  the  last  massage ; 
who  gives  exact  orders  as  to  her  detailed 
routine  throughout  the  day ;  who  ascertains 
she  is  not  roused  and  agitated  by  the  noisy 
cleaning  of  grate  and  room  early  in  the 
morning,  will  do  much  to  ensure  the  general 
success  of  his  elaborate  treatment. 

A  capacity  for  taking  pains  and  for 
arranging  details  of  treatment  may  turn 
the  scale  from  failure  to  success  in  a  doubtful 
case.  So  much,  then,  with  extreme  brevity, 
for  the  doctor  and  his  personal  powers. 

Let  us  now  consider,  in  the  second  place, 
the  conditions  of  success  in  connection  with 
the  patient. 

Here     we    find    that     success    is    greatly  Difficulty 
handicapped  if  the  patient  has  been  already  failures, 
the    victim    of    previous    failures.      As    Dr. 
Allbutt   has   pointed   out,   these   always   act 
prejudicially  in  sapping  the   confidence   and 
courage  of  the  sufferer.     Personally    I   have 


138  NERVES    IN   DISORDER 

found   this   a   most   difficult  complication  to 
deal  with. 

The  mechanical  routine  of  a  so-called 
"  Weir-Mitchell  cure  "  is  now  so  well  known, 
and  so  absurdly  regarded  as  such  a  universal 
panacea,  that  this  or  something  else  has 
often  been  tried  unsuccessfully  before  you 
see  the  patient,  with  the  result  that  anything 
approaching  the  same  methods  is  already 
regarded  with  suspicion ;  though  it  may 
essentially  differ,  and  result  in  success  instead 
of  failure. 
Confidence  Another  element  of  success  in  the  patient 
and  nurse,  is  confidence  in  the  doctor  and  nurse.  I 
add  "  nurse,"  because  many  physicians  are 
not  aware  how  this  person  can  weaken  or 
wholly  frustrate  all  efforts  at  a  cure.  A  case 
occurs  to  me  that,  treated  by  Weir-Mitchell 
method  twice,  only  resulted  each  time  in 
failure  and  actual  loss  of  weight.  Secret 
sapping  of  the  doctor's  influence,  with  neglect 
of  orders,  was  the  cause  in  one ;  and  open 
rupture  of  the  two,  neutralising  all  efforts, 
in  the  other.  The  case  was  difficult,  but 
with  agreement  between  the  two  was  eventu- 
ally successfully  treated. 

I   must   not  omit   here,    as   distinct   from 


MEDICAL   TREATMENT  139 

all  diagnosis  of  the  disease,  and  as  a  great  study  the 

°  °  patient's 

element   of   success,   a    close    study   of    the  person 

ality. 

patient's  personality  and  mental  calibre. 
This  so  often  necessitates,  even  in  two  suffer- 
ing from  the  same  symptoms,  a  course 
of  treatment  in  one  case  entirely  different 
from  that  required  by  another. 

The  personal  factor  is  so  comparatively 
valueless  in  ordinary  physical  diseases,  such 
as  pneumonia  or  gout,  that  one  is  apt  never 
to  consider  it,  until  one  finds,  from  disastrous 
experience  in  functional  nerve  disease,  that 
its  proper  consideration  is  in  its  way  quite 
as  important  as  accurate  diagnosis. 

We  now  come  to  the  methods  of  cure ; 
and  here  it  is  obvious  that,  though  success 
depends  largely  upon  the  physician  and 
much  upon  the  diagnosis,  it  must  depend 
still  more  upon  the  use  of  right  and  adequate 
means. 

In  the  first  place,  then,  with  neurasthenics,  Machine- 

made 

in   the   greater   number  of  cases    "  cast-iron  "cures" 

,,      -  .  „  1  •         useless. 

systems  of  treatment  turning  out  machine- 
made  "  cures  stand  condemned  in  theory 
and  in  practice.  If  one  may  say  a  word 
from    practical    experience,    it    is    that    the 


140 


NERVES    IN   DISORDER 


Methods 

must  be 
adequate. 


chief  cause  of  the  failures  I  have  come 
across  has  been  the  ordering  of  such  and 
such  cure  by  name  (involving  some  fixed 
routine  and  surroundings),  that  failed  because 
not  adapted  or  adaptable  to  the  patient's 
special  needs.  Of  course,  wherever  a  doctor 
has  any  fixed  system,  or  wishes  to  save 
himself  trouble,  these  ready-made  expedients 
are  very  tempting ;  but  we  must  here  lay 
down  as  an  important  condition  of  success 
the  making  a  system  or  treatment  to  suit 
the  patient,  rather  than  a  patient  to  suit 
the  treatment.  It  is  far  otherwise  when 
dealing  with  any  definite  and  well-known 
lesion,  such  as  enteric  fever.  Here  the  more 
of  routine  and  fixed  treatment  often  the 
better. 

I  have  spoken  of  the  adequacy  of  the 
methods  used.  This  adequacy  must  not  be 
judged  by  the  amount  of  potent  drugs  pre- 
scribed, or  the  violence  or  expense  of  the 
agencies  employed.  They  may  range  from 
the  most  elaborate  combinations  of  psycho- 
physical treatment,  conducted  in  a  well- 
appointed  home  with  every  possible  adjunct, 
down  to  a  few  simple  prescriptions,  or  even 
short  medical  talks,  or  a  change  of  environ- 


MEDICAL  TREATMENT  141 

ment  or  occupation,  or  mere  rest,  pure  and 
simple. 

No  method  can  be  decried  as  trivial  that 
succeeds  in  curing  the  patient ;  but,  on  the 
contrary,  that  plan  is  best  that  arrives  at 
this  result  with  the  least  time,  trouble,  and 
expense. 

No   expense,  however,  is  so  expensive  as  iii-heaith 
ill-health,  and   one   of  the   strangest  of  the  expensive 
many  strange  phenomena   that   are  seen  in  cvu^^^  ^ 
otherwise  rational  people  is  the  ungrudging 
way   money   is   spent   on   dress,  jewels,  and 
luxuries,    and     the     short-sighted    economy 
that   is   everywhere   in   evidence  when  it   is 
a  question  of  health,  by  which  alone  these 
luxuries  can  be  enjoyed. 

Most  methods  involve  the  use  of  nurses  Nn 
or  trained  attendants,  or  companions  of 
some  sort;  and  here,  as  we  have  already 
hinted,  is  a  frequent  cause  of  non-success. 
Doctor,  diagnosis,  method — all  may  be  right, 
and  yet  there  is  no  cure  because  the  sub- 
ordinate agents  are  inefficient. 

This  is  not  the  place  to  enlarge  upon  the 
reason  why  this  is  so  frequent,  based  as 
it  is  upon  the  non-recognition  of  the 
great   need  there  is  for  a  class  between  the 


"  nerve 

nurses. 


142 


NERVES    IN    DISORDER 


Neuras- 
thenic 
nurse  not 
yet  pro- 
duced. 


At  present 
the  nurse 
is  born, 
not  made. 


three-years  hospital-trained  and  starched- 
and-ironed  aseptic  nurse  of  the  period,  and 
the  depressing  mental  attendants  known  to 
alienists.  The  neurasthenic  nurse  is  a  being 
yet  to  be  evolved  as  a  definite  product, 
but  she  is  sometimes  met  with  as  a  chance 
growth  in  out-of-the-way  places — frequently 
painfully  ignorant,  alas !  of  the  simplest 
hospital  routine.  The  ordinary  nurse  dis- 
likes the  neurasthenic  cases,  largely  because 
she  does  not  understand  the  reality  of  the 
disease  in  the  absence  of  physical  lesions, 
and  partly  also  because  in  hysterical  cases 
there  is  not  only  the  appearance  of  fraud, 
but  often  a  perverted  mental  bias  that 
takes  pleasure  in  fault-finding,  and  setting 
the  nurse  against  the  doctor,  and  vice 
versa. 

It  is  well  for  the  doctor  to  remember  this, 
and,  even  when  a  nurse  has  to  be  changed, 
to  uphold  the  nurse  to  the  patient  when- 
ever possible,  even  on  therapeutic  grounds. 

Nascitur  non  fit  is  undoubtedly  the  dis- 
tinguishing motto  of  the  mental  nurse,  though 
the  "  fitting "  is  most  necessary  and  useful 
also  ;  but  until  this  is  recognised,  and  the 
nurses  are  to  be  had,  what  is  the  doctor  to 


MEDICAL  TREATMENT  143 

do  ?     Well,   of   course,   he    has   to   cure   his  Hence  the 

.  expense  of 

patient.  At  present,  for  want  of  adequate  cures. 
help,  the  cure  has  often  to  be  effected  by 
his  own  personal  influence  and  visits  to  an 
extent  that  \^ould  not  be  in  the  least 
necessary  were  our  training  system  more 
adequate  and  really  efficient  helps  to  be  had. 
This  is  all  very  well  for  patients  that  can 
pay,  but  is  naturally  very  expensive. 

The  outcome  is,  therefore,  clearly  this, 
that  the  treatment  of  all  difficult  neurasthenic 
-cases  is  necessarily,  and  from  causes  quite 
beyond  the  doctor's  control,  far  more  ex- 
pensive than  that  of  any  other  class  of  disease 
(excluding,  of  course,  any  involving  major 
surgical  operations),  and  far  more  expensive 
than  it  need  be,  were  efficient  nurses  to  be 
had. 

This  question  of  nurses  raises  that  of  On  nursing 
nursing  homes  generally.  In  the  first  place, 
neurasthenics  cannot,  as  a  rule,  be  cured  in 
their  own  homes,  for  what  they  one  and  all 
need  is  rest  in  some  form.  Now,  to  women 
home  is  the  sphere  of  the  greater  part  of 
their  work,  to  the  man  only  is  it  (with  ex- 
ceptions) the  place  of  rest.  Hence  home 
is   obviously   not    the    environment    needed 


144  NERVES    IN   DISORDER 

for  women  ;  and  for  other  reasons  men  also 
are  cured  more  certainly  and  expeditiously 
away  from  their  own  family  circles.  This 
necessitates  the  nursing  home  as  an  indis- 
pensable adjunct  for  at  any  rate  part  of 
the  cure. 
Quality  of        Now,  it  is  not  too  much  to  say  that  the 

home  de- 
termines     quality  of  this  home  largely  determines  the 
success  of 

treatment  question  of  succcss  in  the  treatment.  Nurs- 
ing homes  are  so  frequently  unsatisfactory 
that  many  physicians  have  been  driven  to 
run  their  own.  This  has,  of  course,  its  ad- 
vantages, but  it  has  great  and  serious  draw- 
backs. Of  course  I  am  here  not  speaking 
of  surgical  homes,  or  of  any  treatment  but 
that  of  neurasthenics. 

Personally,  I  have  never  been  able  to  get 
over  the  professional  feeling  that  a  physician 
ought  to  look  to  his  fees,  and  to  his  fees 
alone,  for  payment  for  his  services,  and 
should  not  directly  or  indirectly  run  a  board- 
ing-house under  any  name,  or  share  in  the 
profits  if  derived  from  his  patients. 

Should  It  may,  of  course,  be  urged  that  a  doctor 

doctors  ,  ,  .  .1  , 

have  their  can  have  his  own  nursing  home,  and  yet 
have  nothing  to  do  with  its  management  or 
profits.     In   this  case,  however,  it  is   hardly 


MEDICAL  TREATMENT  145 

his,  though  his  patients  may  go  there  ;  and  of 
course  he  fails  to  have  the  perfectly  free 
hand  in  dietaries — so  all-important — that  he 
has  when  its  pecuniary  management  is  in 
his  hands. 

It  may  not,  indeed,  be  difficult  to  show 
that  it  is  to  the  patient's  own  interest  that 
the  home  should  be  run  by  the  doctor,  and 
many  medical  men  will  see  no  weight  whatever 
in  what  I  urge  against  making  a  profit  from 
board  and  lodging.  One  can  in  this  only  speak 
for  oneself,  and  for  all  others  like-minded. 

At  any  rate,  whether    the   home   be   the 

doctor's    or   the    matron's,   it    must   be    one 

where   the   dietary   is    practically   unlimited, 

where   the   food  can  be   relied    on   to  be  of 

the    best    and   well    cooked,   and,   not   least, 

punctually  served  with  cleanliness  and  nicety. 

The  room  should  be  quiet  and  airy,  and  at 

any   rate    major   surgical   operations   should 

not  be  conducted  in  the  home.     If  possible, 

it    should    have    some    private    grounds    or 

garden  attached  to  it. 

The   matron   or   sister    may   or   may    not  The 

matron, 
actively   co-operate    in    the    treatment,    but 

should  at  any  rate  avoid  the  slightest  adverse 

comment    on    any    methods    she    may    not 


146  NERVES    IN    DISORDER 

understand  or  agree  with.  She  should  be 
prepared  to  change  the  nurse  at  the  doctor's 
request  till  the  patient  is  suited,  and  to 
promptly  carry  out  all  his  orders. 

Treatment       Finally,   we   must    touch   on   one  or   two 

of  neuras- 
thenia        details  which  have  much  to  do  with  success 

proper, 

in  these  cases.  Comparing  the  different 
varieties  of  functional  nerve  disease,  we  may 
say  that  the  treatment  of  neurasthenia  proper 
and  hysteria  is  fairly  distinct. 

In  the  former,  where  the  whole  mental 
system  is  sound,  and  it  is  the  brain  that 
is  worn  out  physically,  while  rest  is  good, 
isolation  is  not  often  needed,  and  over-feeding 
and  massage  can  frequently  be  dispensed 
with.  In  neurasthenia,  moreover,  we  never 
fight  against  the  symptoms,  as  we  have  to 
do  in  hysterical  cases. 
Treatment  These  latter,  too,  require  isolation,  nearly 
always  some  form  of  Weir-Mitchell  "  cure  " 
with  massage,  and  probably  a  large  amount 
of  suggestion,  direct  or  indirect,  which  neur- 
asthenics do  not. 

In  mental  cases,  however,  rest  in  bed  is 
by  no  means  a  routine  matter,  for  it  nearly 
always  aggravates  the  disease.     It  is  also  not 


MEDICAL  TREATMENT  147 

often  of  value,  as  we  have  seen,  if  the  physique 
is  otherwise  good  and  sound,  and  the  nervous 
system  alone  is  overworked  and  weakened, 
as  in  neurasthenia. 

It  is,  however,  generally  needed  in  cases 
of  malnutrition,  in  diseases  of  neuromimetic 
origin,  and  in  doubtful  nerve  cases,  to  give 
time  and  opportunity  fully  to  determine 
the  diagnosis ;  also,  in  severe  nervous  pros- 
tration, even  without  other  physical  lesions ; 
and  in  all  cases  coupled  with  cardiac  in- 
sufficiency. 

Massage   is,  of  course,  always  needed    for  Value  of 

massage. 

digestive  purposes,  to  take  the  place  of  active 
exercise,  where  there  is  entire  rest  in  bed. 
Besides  this,  it  is  of  special  benefit  in  all 
disorders  of  the  circulation,  in  all  wasting 
or  weakness  of  muscles,  in  all  stiffness  or 
weakness  of  joints,  in  most  cases  of  pain, 
in  congestions  of  internal  organs,  in  many 
forms  of  cardiac  disease. 

To  some  massage  is  a  severe  trial,  to 
others  a  great  pleasure.  It  is,  however,  a 
necessity  to  all ;  but  its  value  to  some  extent 
depends  on  the  personality  of  the  masseuse. 
She  can  do  much  to  help  the  treatment, 
and    not    a   little    to    hinder   it.      The   skill 


148  NERVES    IN   DISORDER 

also  varies  greatly,  and  to  those  who  dislike 
it  this  is  of  special  importance. 

Isolation.  The  question  of  friends  and  relatives  is 
a  difficult  one,  and  is  not  answered  by  the 
simple  rule  of  complete  isolation.  This  is 
invaluable  in  hysterical  cases,  wherever  it 
can  be  carried  out  without  too  much  de- 
pression or  irritation  of  the  patient ;  but 
there  are  many  cases  where  too  rigid  in- 
sistence on  it  means  failure,  either  from  the 
patient  leaving  in  consequence,  or  from  the 
bad  results  on  the  nervous  system.  Here, 
as  elsewhere,  success  follows  an  intelligent 
combination  of  flexibility  with  firmness. 

Suggestion.  Lastly,  a  word  as  to  "  suggestions." 
These,  as  pointed  out  in  the  previous 
chapter,  can  seldom  be  assimilated  if  made 
directly. 

We  must  remember  one  great  point  with 
regard  to  suggestion — that  it  is  like  nitrogen. 
Nitrogen  is  the  essential  element  in  all 
animal  life — it  forms  four-fifths  of  the  air 
we  breathe ;  and  yet,  curious  to  say,  we 
have  no  power  to  use  it  in  a  pure  state. 
We  can  only  take  it  indirectly,  when  com- 
bined with  other  substances  in  the  form  of 
proteid  food.     It  is   the  same  with  sugges- 


MEDICAL  TREATMENT  149 

tions.      Not    one    hysterical    sufferer    in     a 

hundred  can   receive  and    profit  by  them  if 

made  directly — that  is,  consciously  ;  they  must 

generally    be    presented,    as    we    have    said, 

indirectly   to   the   unconscious    mind  by  the 

treatment   and   environment   of  the   patient. 

An  electric  shock  often  cures  slight  hysterical 

diseases    instantaneously,    more    particularly 

if    it   is   expected   to   do   so ;    acting,   as    it 

does,  on  the  unconscious  mind  through  the 

conscious. 

No  doubt  it  would  be   easier  if  we  could  Best  given 

say  to  these  sufferers,  "  The  disease  is  caused 

by   suggestions   from   ideal   centres,  and,   to 

cure  it,  all  you  have  to  do  is  to  believe  you 

are  well  "  ;  and,  indeed,  with  a  very  few  this 

can  be  done  with   success,  even   in   cases  of 

some  gravity,  while  in  very  slight  symptoms 

of  "  nervousness  "  this  direct  auto-suggestion 

is   quite   successful.      Still,    as   it   would   be 

impossible  fcftr  us  to  take   our  nitrogen  pure 

from  the  air,  the  mind  cannot  as  a  rule   be 

thus   acted    on   directly   when    the   brain   is 

unhealthy :  suggestion   must  be  wrapped  up 

in    objective    treatment.      Hypnotism    is   ofHypno- 

■'  .  -^  ^  lism. 

doubtful     benefit     in     most    neurotic    cases. 

Some  patients,  as  we  have  seen,  and  many 


ISO  NERVES    IN   DISORDER 

of  low  mental  calibre,  are  benefited  by  the 
direct  suggestion  that  they  are  rapidly 
getting  well  ;  more,  however,  benefit  by 
the  use  of  means  directed  to  combat  the 
symptoms  complained  of — such  as  elec- 
tricity, massage,  drugs,  exercises,  etc. — which, 
besides  doing  a  very  great  amount  of  good 
directly,  do  still  more  by  the  suggestions 
they  convey  to  the  patient's  mind,  and 
thus  afford  a  rational  prelude  to  an  in- 
telligible cure.  They  appeal  to  the  patient's 
reason,  and  afford  satisfactory  food  to  the 
mind,  which  finds  a  very  natural  gratification 
in  the  use  of  extensive  and  elaborate  means. 
Thoi'0*t.  Another  form  of  indirect  suggestion,  that 
can  only  be  administered  by  a  physician 
who  is  in  the  fullest  confidence  of  his 
patient,  is  that  which  points  out  the  evil 
and  the  weakness  and  the  folly  of  that 
character  of  mind  that  feeds  upon  itself; 
and  that  draws  out  the  mind  to  altruistic 
and  worthy  objects,  and  thereby  alters  the 
flow  of  the  unconscious  current  of  thought, 
which  has  been  feeding  the  disease  all 
through ;  and  thus  makes  the  subconscious 
mind  itself  undo  the  mischief  it  has  done. 
Other  details   important  enough   to  effect 


•urning. 


MEDICAL   TREATMENT  151 

success  are  the  management  of  dyspepsia, 
circulation,  sleeplessness,  constipation,  rest- 
lessness, depression,  and  other  troublesome 
symptoms. 

In  neurasthenia,  quite  as  much  as  in 
hysteria,  the  beneficial  influence  of  real 
confidence  in  the  doctor  is  very  marked  ; 
and  when  this  is  assured,  the  patient  makes 
rapid  progress,  owing  to  its  stimulating  effect 
upon  his  unconscious  mind. 

The    personal    factor    must    bulk    largely  Personal 

°     '    influence 

in  all  cures  of  functional  nerve  disease,  of  doctor, 
and  its  value  must  be  recognised  and 
used,  always  with  wisdom  and  care,  lest 
that  which  is  a  valuable  aid  to  health  be 
used  as  a  crutch  to  support  ill-health.  It 
is  here  indeed  that  the  practical  wisdom 
of  the  medical  man  comes  in ;  for  the  mental 
factor  and  influence  may,  like  any  drug, 
be  abused  as  well  as  used,  and  overdoses 
may  drug  or  even  poison  the  patient  as  much 
as  opium  or  chloral.  A  moment's  reflection, 
indeed,  will  show  that  no  power  so  strong 
as  the  "  force  of  mind  "  can  be  used  without 
due  care. 

Fmally,   in   most   nerve   cases,    to    ensure  After- 

treatmeot. 

a  permanency  in  the  cure,  the  patient  should 


152  NERVES    IN   DISORDER 

not  return  to  the  surroundings  connected 
with  his  diseased  state.  An  effort  should 
be  made  to  find  out  his  tastes  as  regards 
place,  occupation,  sports,  and  amusement, 
and  the  definite  directions  given  (which 
should  never  be  omitted)  as  to  after-life, 
for  at  any  rate  some  months,  should  as 
far  as  possible  coincide  with  the  natural 
bent  of  the  patient's  interests. 
CycUne  It  may  be  borne  in  mind  that  in  cycling 

'"   ^       and   golf  we   have   now   two   favourite    and 
powerful  therapeutic  agencies. 

For  the  successful  treatment,  then,  of 
nerve  diseases  of  all  sorts,  we  need  much 
that  might  be  taught  in  the  schools,  but 
is  not,  and  much  that  cannot  be  taught  in 
any  school.  I  consider  that  the  successful 
nerve  doctor  owes  less  to  his  teachers  and 
more  to  his  idiosyncrasy,  experience,  and 
applied  common  sense  than  any  other  variety 
of  medical  man. 


Special  So   far  we   have    spoken   of  the    cure  of 

treatment  ttt  mi 

inneuras-    functional  nerve  disease  generally.     We  will 

thenia.  .  .  ... 

now  note  a  point  or  two  in  connection  with 
neurasthenia  as  distinguished  from  neuro- 
mimesis  (or  hysteria). 


MEDICAL   TREATMENT  153 

In  the  treatment  of  these  cases,  if  other- 
wise healthy,  we  have  this  great  advantage 
over  hysteria,  that  in  nervousness  the  main 
cause  is  nearly  always  external  to  the  patient, 
whereas  in  hysteria  it  is  nearly  always  within 
the  brain  itself.  On  the  other  hand,  we  must 
remember  that,  while  it  is  the  tendency  of 
cases  of  hysteria  suddenly  to  get  well  under 
treatment,  cases  of  nervousness  never  do,  but 
always  require  a  considerable  length  of  time. 

The    first   great    means    of  cure   in   neur-  Remove 

cause  in 

asthenia  is  obviously  to  remove  the  principal  neuras- 
cause  ;  and  whenever  the  disease  is  clearly 
recognised,  this  must  be  done  at  all  costs. 
That  is  to  say,  whether  it  is  school,  college, 
business,  professional  or  public  work,  it 
matters  not,  it  must  be  stopped  for  a  time 
at  once ;  for  it  must  be  remembered  that 
every  month's  delay  may  mean  at  least 
double  that  extra  time  in  cure.  If  the 
trouble  has  been  brought  on  through  pro- 
longed overwork  or  worry,  total  rest  may 
be  best.  If  it  is  through  cessation  of  hard 
work,  and  want  of  employment  of  the  brain 
in  its  accustomed  way,  some  steady  healthful 
occupation  must  be  prescribed  and  carried  out. 
If  it  is  a  slight  case  of  over-pressure  in  one 


154  NERVES    IN   DISORDER 

special  pursuit,  total  change  of  work  to  some 
other  line  may  suffice. 

It  may  be  that  this  brain  or  spine  irritation 
is  set  up  by  some  cause  outside  the  head, 
but  inside  the  body — as  by  certain  objection- 
able habits  not  uncommon  amongst  growing 
boys  and  girls,  by  over-eating,  by  spirit- 
drinking,  or  by  tight-lacing. 
Cause  can        In  any  case  the  cause  should  be  carefully 

generally 

be  re-  sought  out,  and  in  nearly  every  case  it  will  be 
found  to  be  something  which  the  patient  can 
and  must  lay  aside  as  a  first  means  of  cure. 
The  symptoms  may  be,  of  course,  due  to 
some  organic  cause,  such  as  a  growth  in  the 
brain,  or  trouble  in  some  internal  organs;  but 
nerve  symptoms  arising  from  these  do  not 
properly  constitute  the  disease  of  nervousness. 
We  must  also  remember  that  many  people 
are  "  nervous "  even  when  in  health,  from 
being  of  a  nervous  temperament  and  coming 
Natural  of  a  nervous  parentage.  The  symptoms  here, 
symp  oras.  [-j^Q^g]^  resembling  those  we  have  described, 
need  not  excite. apprehension,  being  natural 
to  the  individual.  It  is  when  a  person,  not 
naturally  prone  to  these  symptoms,  begins 
from  a  certain  date  suddenly  or  gradually 
to  develop  them,  that  we  recognise  the  onset 


MEDICAL   TREATMENT  155 

of  a  distinct  disease  known  as  "  nervousness," 
or  neurasthenia. 

Having-  thus  removed  the  initiatory  cause  Observe 

^  •'  the  five 

of  the   disease,  whatever   it  may   be  and  at  laws  of 

health. 

whatever  cost,  we  proceed  to  further  steps. 
These  consist  of  temporary  change  of  scene 
and  life,  of  the  careful  observance  of  the  five 
laws  of  health — good  food,  pure  air,  proper 
clothing,  cleanliness,  and  suitable  exercise 
and  rest — and  of  the  use  of  certain  drugs. 

If  the  body  is  sound  and  the  health  good,  Travel 

generally 

the  change  will  generally  take  the  form  of  beneficial. 
foreign  travel  by  land  or  sea.  This  travel 
must  not  be  hampered  by  too  fixed  plans, 
by  insufficient  means  or  insufficient  time, 
or  by  uncongenial  society.  In  some  cases 
the  sufferer  had  best  be  alone,  in  others  some 
wise  and  cheerful  friends  should  go  ;  and  in 
the  worst  cases  a  young  medical  man  would 
be  best.  If  the  case  has,  however,  been 
allowed  to  progress  to  nervous  debility,  no 
such  measures  are  possible  at  first. 

Carelessness  in  this  respect,  of  not  recog- 
nising and  curing  nervous  irritation  till  it  has 
proceeded  to  nervous  exhaustion,  has  led  to 
deplorable  results,  not  only  in  wasting  hundreds 
of  pounds  and  months  of  time,  but  in  dragging 


156  NERVES    IN   DISORDER 

a  worn-out  body  about  on  what  may  truly 
be  called  "  a  wild  goose  chase,"  often  leading 
to  loss  of  life  or  permanent  loss  of  health. 
When  shall  we  learn  that  no  nerve  cases, 
unlike  other  diseases,  can  be  successfully 
treated  by  any  routine,  but  that  each  case 
must  be  separately  and  intelligently  studied 
on  its  own  merits,  for  no  two  are  alike  ? 
Value  of         All  cases   of  debility,   therefore,   must  be 

rest  in  bed.  -.11  1         1         i- 

put  to  bed,  preferably  under  the  direct  care 

of  doctor   and    nurse,   and    apart   from    the 

too  sympathetic   surroundings   of  home  and 

friends :    though   this   is    by   no   means    the 

sine    qud   non   in   these   cases   that   it   is    in 

hysteria.      The    strength    must    be    quietly 

restored   and    the    system    rebuilt    by    food, 

massage,    electricity,    and    rest.      This     rest 

will,  of  itself,   combined   with   the   vivifying 

influence  of  new  brain  material,  do  a  great 

deal  towards   not   only   curing   the   physical 

debility,  but  the  nerve  trouble  as  well ;  and 

afterwards     the    therapeutic    force    of    new 

impressions,  and    perhaps  a  certain   amount 

of  medicinal  aid,  will  complete  the  cure. 

One  or  two  special  points  in  treatment 
may  be  mentioned  here. 

In  combating  sleeplessness  in   these  cases 


MEDICAL  TREATMENT  157 

opium  is  not  a  useful  drug,  and  should  not 
be  used.  Coffee  (strong)  and  tea  sometimes 
aggravate  the  disease,  but  sometimes  are 
beneficial. 

As  a  guide  to  treatment  we  may  remember  Guide  to 

treatment. 

that,  though  many  of  the  symptoms  of 
nervousness  are  similar  to  those  of  anaemia, 
in  the  former  disease  the  blood  is  of  good 
quality  and  there  is  no  weakness  of  the 
heart,  while  in  the  latter  it  is  very  poor  and 
there  is  some  weakness.  There  may,  of 
course,  be  combinations  of  the  two,  for 
anaemia  paves  the  way  to  nerve  irritation. 
Iron  is  of  use  in  both  diseases.  Again,  if 
these  symptoms  arise  from  organic  disease, 
we  find  the  reflex  action  of  muscles,  such 
as  the  knee  jerk,  diminished ;  whereas  in 
functional  nervousness  they  are  increased. 
Again,  if  the  seat  of  the  nerve  trouble 
be  in  the  brain,  walking  is  a  very  good 
remedy ;  if  in  the  spine  it  is  bad,  and  often 
cannot  be  undertaken  for  some  time. 

The  leading  drugs  that  have   been   found  Pharmacy, 
of  some  power  in  this  special  disease,  more 
particularly  in  America,  where   alone  it   ap- 
pears to  have  been  thoroughly  studied,  are : 
ergot,   arsenic,   Indian   hemp,    caffeine,  coca, 


158  NERVES    IN    DISORDER 

salts  of  zinc,  and  bromides,  with  Fowler's 
solution.  All  require  careful  administration 
under  direct  medical  advice  for  definite 
limited  periods.  Cod-liver  oil  is  also  of  use ; 
and  galvanism  in  the  first  stage,  and  faradisa- 
tion and  galvanism  in  the  second.  So-called 
galvanic  belts  are  useful  only  by  occasionally 
acting  through  the  mind  by  faith.  Their 
supposed  galvanic  power  is  practically  of 
as  little  direct  use  as  the  "  liquid  "  electricity 
of  the  late  Count  Mattel 

AftcMure.  The  after-cure  of  neurasthenics  is  always 
a  matter  of  anxiety :  as  a  broad  rule,  one 
may  say  that  the  seaside  and  an  altitude 
over  2,000  feet  do  not  suit  most,  but  a 
voyage,  woods,  and  lower  mountain  slopes 
do.  The  pursuit  of  one's  favourite  outdoor 
sport  or  occupation,  with  moderate  cycling, 
is  a  good  general  scheme. 

Which  In  voyages  for  rest  in  nerve  irritation,  the 

voyages  1       a  1  •  1 

are  best  Cape  and  Australia  are  best ;  m  voyages 
after  partial  restoration  from  nervous  debility, 
the  Mediterranean,  India,  and  America  are 
preferable,  because  they  are  more  lively. 

As  a  rule,  the  treatment  is  and  must  be 
tedious,  and  should  be  about  the  same 
length  as  the  disease.     When  the  patient  is 


MEDICAL    TREATMENT  159 

restored,  he  need  never  relapse  if  his  after-life 
is  regulated  by  common  sense  and  hygiene. 

Travelling  long  distances  to  town  daily 
may  produce  this  disease,  and  after  a  cure 
the  travelling  must  not,  of  course,  be  re- 
newed, but  a  move  made  nearer  to  business. 
In  neurasthenia  there  is  a  distinct  danger  Alcohol 
of  alcoholic  stimulants,  the  use  of  v/hich  thenia. 
should  always  be  controlled  by  the  doctor. 
There  is  no  disease  whose  beginnings  are 
more  easily  checked,  or  whose  advanced 
stages  are  more  difficult  to  cure. 

In  summing  up  the  treatment  ol  this 
disease  in  either  stage,  we  would  say  :  first 
make  sure  of  the  diagnosis  as  to  the  disease 
being  a  functional  irritation  or  exhaustion 
of  the  nerve  centre  in  brain  or  spine ;  and 
then,  having  made  sure  that  the  disease  is 
actually  there,  find  out  the  real  cause  or 
causes  that  produced  it. 

And   now  we  come  to  the  medical  treat-  Treatment 
ment  of  neuromimesis,  the  form  of  hysteria  mimesis." 
with  which  we  are  specially  concerned  here. 

With  regard,  then,  to  the  cure  of  neuro- 
mimetic  hysteria,  it  is  most  important  that, 
like  neurasthenia,  it  be  undertaken  as   soon 


l6o  NERVES    IN    DISORDER 

as  the  disease  is  clearly  recognised  ;  for  we 
must  remember  there  is  always  a  danger  of 
the  want  of  use  of  any  part  leading  to  real 
organic  disease  of  that  part,  often  in  a  very 
short  time,  and  in  emotional  hysteria  may 
possibly  develop  into  other  brain  disorders. 
The  mode  of  treatment  must,  of  course,  vary 
with  the  character  and  gravity  of  the  disease  : 
certain  general  principles,  however,  can  be 
safely  laid  down.  But,  first  of  all,  it  may  be 
broadly  stated  that  no  one  can  successfully 
undertake  such  cure  unless  he  fully  recognise 
the  origin  of  the  disease,  its  gravity,  its  real 
nature,  and  its  distressing  character.  The 
doctor  should  be  full  of  sympathy,  but,  except 
in  rare  instances,  show  none. 
Is  it  The  first   thing,  of  course,  is  to  ascertain 

only?  that  the  disease  is  hysteria  07ily.  Now  this 
is  a  most  difficult  thing  to  verify  in  these 
patients,  and  nothing  is  more  common  than 
to  find  a  disorder  of  the  mind  treated  as  a 
disease  of  the  body  ;  but  on  the  other  hand 
it  does  happen  at  times  that,  in  trying  to  avoid 
this  error,  diseases  of  the  body  are  mistaken 
for  diseases  of  mental  origin  only. 

As  I  write  this,  three  such  cases  are  brought 
before  me. 


MEDICAL  TREATMENT  i6i 

One  is  that  of  a   broken    leg,  which  was  Organic 

disease 

set,  but  when  examined  a  fortnight  after  for  mistaken 
excessive   pain  was  diagnosed  as  a  nervous  hysteria, 
affection   and   treated  by  massage,  with  the 
result  of  preventing  the  union  ;  the  true  state 
of  the  case  being  revealed  by  the  Rontgen  rays. 

Another,  that  of  a  boy  of  very  nervous 
temperament,  whose  parents  were  repeatedly 
assured  by  medical  men  of  standing  that  the 
constant  pain,  sweats,  and  loss  of  flesh  were  due 
to  "  nerves  "  alone,  until  sudden  hemorrhage 
revealed  tuberculosis  that  had  been  long  there. 

A  third,  that  of  a  girl  diagnosed  to  have 
"  hysterical  "  pain  in  the  hip,  for  which  violent 
movements  were  prescribed,  until  after  a 
fortnight  the  Rontgen  rays  revealed  disloca- 
tion of  the  joint.     Of  course  on  the  other  Mistakes 

•II-  •  ^  ^         r  made  on 

Side  the  nistances  are  mnumerable  of  nervous  both  sides, 
disease  being  diagnosed  as  organic,  and  many 
a  patient  has  lost  his  leg  through  "hysterical" 
knee-joint  disease. 

The  serious  mistakes  thus  made  on  both 
sides  by  eminent  and  skilled  surgeons  and 
physicians  indicate  the  extreme  difficulty 
at  times  of  arriving  at  the  truth,  and  the 
great  care  needed  in  diagnosis. 

If  there  is,  however,  after  careful  examina- 


i62  NERVES    IN   DISORDER 

tion,  clearly  no  organic  disease  at  the  bottom, 
then  the  case  must  be  one  arising  from  nerve 
disorder,  the  cause  of  the  nerve  disorder 
being  either  physical  or  mental,  or  often  a 
combination  of  both ;  the  brain  being,  of 
course,  wholly  dependent  for  healthy  action 
on  good  blood. 
The  vicious      ^  vicious  circle  is  often  kept  up  in  these 

circle.  ■•■  '■ 

cases  which  it  is  absolutely  essential  to  break. 
They  begin,  it  may  be,  with  loss  of  appetite 
from  some  slight  cause.  This,  in  these  cases, 
leads  to  disordered  thoughts,  and  the  idea 
of  disease  is  started.  This,  again,  makes  the 
appetite  still  more  capricious  ;  the  thoughts 
therefore  get  still  worse,  and  so  the  body 
starves  the  brain,  and  the  brain  the  body ; 
and  the  emaciated  patient,  having,  probably 
enough,  first  of  all,  worn  out  her  friends,  sinks 
at  last  into  her  grave  from  sheer  starvation. 
I  have  seen  such  deaths. 
Travelling       ^he    pernicious  practice  of  sending   these 

often  a  '■ 

mistake,  patients  to  travel  here  and  there  in  search 
of  health  cannot  be  too  strongly  condemned, 
and  in  my  experience  has  led  to  most 
disastrous  results.  The  Continent  is  full  of 
these  miserable  parties  of  pale-faced  sufferers, 
with    their    anxious    relations    and    friends. 


MEDICAL  TREATMENT  163 

wandering  despondently  about  in  search  of 
what  they  will  never  find  there.  The  worst 
cases  I  have  ever  met  with  are  of  this  order, 
and  have  come  for  treatment  direct  from 
the  midst  of  some  futile  tour ;  and  I  cannot 
but  think  such  cases  are  often  sent  abroad 
as  a  last  resource  by  physicians  who  have 
never  really  grappled  with  the  question  as 
to  how  such  diseases  can  alone  be  cured. 

The  first  thing  obviously  is  to  re-make  as  Re-make 

body  and 

far  as  possible  the  vitiated  body  and  brain  brain, 
with  fresh  flesh  and  blood  and  nerve ;  and 
then,  when  we  have  put  the  patient  into 
the  best  possible  bodily  health,  we  shall 
have  cured  the  physical  cause  of  the  nerve  dis- 
order at  any  rate.  Then,  or  even  simultane- 
ously, any  mental  and  possibly  moral  cause 
in  the  unconscious  mind  must  be  deliberately, 
scientifically,  and  systematically  attacked  by 
the  careful  substitution  of  good  habits  of 
thought  and  action  for  bad.  This  is  done 
mainly  by  suggestion,  but  without  any  of 
the  doubtful  and  unpleasant  accompaniments 
of  hypnotism. 

Hypnotism  is  indeed  by  no  means  specially  Hypnotism 
suited  for  hysterical  cases.     Ernest  Hart,  who  successfioi 
collected  much  information  at  the  Salpdtrifere,  "^  y^'*™* 


l64  NERVES    IN    DISORDER 

writes :  "  Charcot,  Richet,  Babinski,  and 
others  have  concluded  that  for  curative  pur- 
poses hypnotism  is  very  rarely  useful,  gener- 
ally entirely  useless,  and  often  injurious." 

As  a  matter  of  fact,  useful  therapeutical 
suggestions  can  perfectly  well  be  made 
naturally  without  hypnotism.  At  present 
its  use  is  perhaps  greatest  in  affording  a 
unique  means  for  investigating  obscure  psychic 
phenomena.  In  this  direction  it  is  far  more 
successful  than  in  therapeutics. 

It  is  not,  however,  enough  in  mental  thera- 
peutics to  present  good  suggestions  ;  we 
must  also  remove  previous  bad  ones.  Such 
a  patient  must  therefore  be  isolated,  to  avoid 
conversations  about,  and  sympathy  being 
shown  with,  the  patient's  sufferings  ;  all  of 
which  keep  up  the  action  or  vibration  of  the 
diseased  ideal  centres. 
Range  of         The  range  of  mental  therapeutics  is,  how- 

mental  ,,      .       ,  ,  .      , 

thera-  cver,  by  no  means  limited  to  hysterical 
diseases.  The  powers  of  the  unconscious 
mind  are  such  that  we  can  place  no  limits 
to  its  influence.  When  the  mind  is  really 
unsound,  it  is  interesting  and  remarkable — 
though  quite  intelligible — to  notice  that  mental 
therapeutics  generally  fails  ;  obviously  because 


MEDICAL  TREATMENT  165 

the  conscious  psychic  element  through  which 
it  should  act  is  in  itself  disorganised.  From 
what  has  been  said,  it  will  be  gathered  that 
in  ordinary  and  some  nervous  diseases,  while 
mental  therapeutics  acts  largely  through 
the  unconscious  mind,  it  can  also  be  success- 
fully presented  directly  to  the  intelligence ; 
and,  on  the  other  hand,  in  true  hysteria 
nearly  all  the  work  has  to  be  done  uncon- 
sciously, the  conscious  mind  being  fixed,  not 
on  mental  therapeutics,  but  on  the  outward 
means  used.  Suggestions  are  often  ad- 
vantageously directed  to  the  sound  parts 
of  the  body,  leaving  the  diseased  part 
severely  alone. 

Suggestion  in  hysteria  is  said  to  cure  the  ideas  not 
physical  condition  through  an  intermediate  cult, 
emotional  change — in  short,  by  a  feeling 
rather  than  a  thought.  It  must  of  course 
begin  with  an  idea  ;  but  when  the  doctor- 
moralist  tries  to  inculcate  a  valuable  fixed 
idea,  it  must  not  be  too  far  off  or  difficult 
of  comprehension.  Such  ideas  often  fail  of 
their  effect  with  indolent  neuropaths,  who 
are  all  more  or  less  afflicted  with  mental 
myopia.  The  moment  the  new  idea  or 
suggestion   is   adopted,  it   begins  to  act  on 


I66  NERVES    IN    DISORDER 

the    body    through    the    unconscious    mind 
exactly  like  a  drug. 
Cures  The  best  cures  of  hysteria  are  naturally, 

effected  by  ^  . 

.aicon         therefore,   effected   through   the   unconscious 

r.ii'  mind.  If  the  case  is  in  every  way  m  good 
health,  and  has  not  entered  the  vicious 
circle  of  dyspepsia  and  debility,  it  may  be 
cured  instantaneously  by  applying  to  the 
irritated  ideal  centres  that  keep  up  the 
disease  good  suggestions,  consciously  or  un- 
consciously, sufficiently  powerful  to  overcome 
the  bad  ones.  Suggestions  are  thoroughly 
effectual  if  one  uses  the  boldness  and  force 
of  which  Sir  James  Paget  speaks,  and  has 
gained  the  respect  and  trust  of  one's  patient. 
If  all  this  appears  as  novel  as  some  of 
the  terminology  here  used,  it  is  simply 
because  mental  therapeutics  is  still  the 
Cinderella  of  medical  science,  for  it  is  yet 
very  dubious  orthodoxy  to  suggest  that 
there  can  be  any  means  of  cure  more  potent 
than  those  found  within  the  revered  pages 
of  the  British  Pharmacopoeia, 
^tionai  This  rational  and  psychic  treatment  is, 
psychic  however,  certainly  gaining  ground.  It  has,  as 
we  have  said,  a  negative  and  a  positive  side. 
The  negative  consists  in  removing  injurious 


MEDICAL   TREATMENT  167 

influences  from  the  patient's  mind,  whether 
they  be  objective  from  the  outer  world,  or 
subjective  from  the  patient's  own  disordered 
thoughts  ;  the  positive,  in  infusing  into  the 
patient's  mind  curative  mental  influences, 
such  as  hope  and  rational  ideas,  which  tend 
to  counteract  the  unsound  mental  action. 
It  is  needless  to  say  that  a  successful  doctor 
requires  in  this  a  combination  of  tact,  know- 
ledge of  human  nature,  patience,  and  temper 
that  all  do  not  possess. 

Such  tact  and  character  are  every  whit 
as  conducive  to  success  as  a  scientific 
equipment. 

It   is  important  to   remember  that,  when  Healthy 

brain  sxcr- 

the  brain  is  restored  to  health  by  good  nerve  cises  gocd 
tissue  and  healthy  blood,  it  can  be  made  by 
suggestion  to  exercise  as  healthy  an  influence 
over  the  body  as  previously  it  exercised  a 
harmful  one.  If  ideal  centres  can  produce 
ideal  diseases,  surely  the  rational  cure  is  by 
first  bringing  these  ideal  centres  into  a 
healthy  condition,  and  then  making  them  the 
means  of  curing  the  ideal  disease.  Mental 
disease  requires,  and  can  ultimately  only 
be  cured  by,  mental  medicine.  When  will 
this  be  understood?    And  when  will  nauseous 


l68  NERVES    IN    DISORDER 

drugs  cease  to  be  ministered  to  a  raind 
diseased  ?  Of  the  usual  remedies  given,  Dr. 
Russell  Reynolds  says  : — 

"  The  whole  list  of  anti-hysteric  remedies — 
musk,  castor,  valerian,  and  the  like — appear 
to  have  this  one  property  in  common :  that 
they  do  no  good,  and  delay  the  real  treat- 
ment of  the  case,  which  is  not  one  to  be 
cured  by  nauseous  '  gums,'  but  largely  by 
mental,  moral,  and  social  management." 

Tonics,  in  helping  to  build  up  the  new 
flesh  and  blood,  are,  of  course,  valuable. 
Electricity.  Electricity,  properly  applied,  is  also  a 
therapeutic  aid  we  can  seldom  wholly  dis- 
pense with ;  and  the  reason  of  its  value  is 
obvious  when  we  consider  it  is  the  most 
powerful  agent  that  we  possess  for  direct 
action  on  the  nerves. 

If  the  case  be  a  severe  one  it  must  be 
withdrawn  from  all  its  surroundings  during 
the  cure;  and  afterwards,  if  these  are  bad, 
it  must  never  return  to  them  again. 

Such  are  a  few  bare  general  outlines  of 
methods  that  have  to  be  varied  to  suit 
each  separate  case.  We  may  now  briefly 
recapitulate  one  or  two  points. 

Bear    in     mind    that    perhaps    the    most 


MEDICAL  TREATMENT  169 

powerful    curative    agent    at    your    disposal  import- 
is  a  suggestion  properly   conveyed.     If  you  suggestion 
have  confidence,  and  have  gained  the  respect 
and  trust  of  your  patient,   you   can    suggest 
and     produce     many     symptoms.      If,     for 
instance,     you    press    some    particular    part 
of  the   spine   or    elsewhere,    and    say,   "  Do 
you  feel  any  pain  here  ?  "  he  will  say  "  No.' 
But   if  you  persist  in   your   suggestion  half 
a  dozen  times,  and  the  nervous    centres   are 
at   all   susceptible,  he   will   say   "  Yes,"   and 
the  pain  suggested  by  you  will  be  felt. 

Now,  is  it  not  rational  to  believe,  even 
if  we  have  not  positive  proof,  that  if  you 
can  produce  pain  in  a  joint  by  suggestion, 
you  can  take  away  suggested  or  hysteric 
pain  by  the  same  means,  and  by  the  same 
means  alone  ? 

Then  isolation  under  the  doctor's  care  and  of 
for  a  while  is  nearly  always  necessary ; 
because  the  suggestions  that  the  disease 
is  local  are  generally  kept  up  by  the  friends 
and  relatives — unless,  indeed,  they  fly  to 
the  opposite  extreme,  which  is  as  bad  or 
worse,  and  say  it  is  all  sham  and  nonsense. 
It  is  so  difficult  not  to  do  harm  by  sym- 
pathising with  the  patient's   sufferings ;  and. 


I70  NERVES    IN   DISORDER 

for   many  reasons,    few   difficult    cases    can 

be  cured  unless  the  environment  be  wholly 

changed,  and  specially  adapted  for  the  cure. 

Newbrain       A   new  brain   is    then   built    up    of   new 

IS  built  up.  _  *■ 

healthy  tissue  by  the  well-known  methods, 
modified  as  needed,  in  about  a  month  ; 
during  which  it  is  kept  free  from  all  bad 
suggestions,  and  at  the  same  time  in- 
sensibly and  unconsciously  brought  under 
the  healing  power  of  good  ones.  This 
building  up  is  nearly  always  required  if 
the  disease  is  of  any  standing  ;  for  we  must 
remember  that,  the  nerves  being  the  one 
channel  through  which  all  energy  is  con- 
veyed to  every  part  of  the  body,  when  they 
go  wrong  the  whole  body  soon  gets  wrecked. 
No  details       We  do  not  give   any   detailed   particulars 

of  treat-  °  .      . 

mentgiven.  of  treatment,  simply  because  it  is  absolutely 
impossible  to  do  so  ;  and  any  one  who  starts 
off  with  an  implicit  faith  in  massage  or 
electricity,  or  Weir-Mitchell  or  any  other 
man,  and  treats  his  patients  by  any  fixed 
routine,  is  almost  bound,  from  the  very 
protean  nature  of  the  disease,  to  fail. 

I  must  add  here  one  word  about  religion. 
While  it  is  true  that  the  morbidness  and 
over-introspection    that    accompany    various 


MEDICAL  TREATMENT  171 

■sorts  of  fanaticism  form  one  of  the  greatest  Value  of 

°  true  Chns 

■emotional  causes  of  hysteria,  on  the  other  tianity. 
hand  true  Christianity  in  its  Divine  sim- 
plicity as  taught  by  its  Founder  is  most 
beneficial  to  the  mind.  Dr.  Ormerod  may 
be  quoted  here.  He  says :  "  Few  things 
are  more  opposed  to  hysteria  than  the 
trustful,  patient,  altruistic  spirit  inculcated 
by  Christ ;  and  few  things  more  conducive 
to  it  than  the  excitement  seen  in  revivals, 
or  the  mysticism  or  self-conceit  which  some- 
times poses  as  religion." 

As  in  all  else,  it  is  the  true  that  helps; 
the  imitation  only  harms. 

Here,  therefore,  we  bring  our  remarks  to 
a  conclusion.  Enough  has,  perhaps,  been 
said  to  rescue  nervous  sufferers  from  the  un- 
deserved contempt  with  which  their  diseases 
are  so  often  treated,  not  only  by  their  friends, 
but  even  by  their  doctors ;  to  show  the 
real  character  of  the  disease ;  and,  further, 
to  indicate  the  lines  of  rational  treatment, 
by  which  cases  of  any  gravity  can  alone 
be  cured. 


A  SHORT   GLOSSARY 

Addison's  Disease. — A  disease  where  the  skin 

becomes  very  dark  in  colour. 
/Etiology. — An    account    of    the    causes    of 

disease. 
Agoraphobia. — A  fear  of  crowds  or  open  places. 
Alienist. — A  doctor  for  disordered  minds. 
Aliment. — Nourishment. 
Amnesia. — Loss  of  memory  for  words. 
AncBsthesia    {without    ancssihetics). — Loss    of 

consciousness  (without  chloroform,  ether, 

etc.). 
Aneurism. — A  tumour  containing  blood. 
Angina  pectoris. — A   disease    of  acute   pain 

in  the  heart. 
Anodyne. — A  medicine  that  relieves  pain. 
Anorexia. — Dislike  to  food. 
Anuria. — Suppression  of  urine. 
Aorta. — The   large   artery  leading   from  the 

heart. 

173 


174  A  SHORT   GLOSSARY 

Aphasia. — Loss  of  speech. 
Aphonia. — Loss  of  voice. 
Apnoea. — Stoppage  of  respiration. 
Arteriosclerosis. — A   hardening  of  the  walls 

of  the   arteries,  seen   in  gout,   old   age, 

etc 
Atonia. — Want  of  tone. 
Atrophy. — Wasting  of  muscles. 
Auto-suggestion. — Self-suggestion  when   fully 

conscious  without  hypnotism. 
Borborygmi. — Internal  rumblings. 
Cerebration. — Action  of  the  brain. 
Cheyne  Stokes  respiration. — A  form  of  inter- 
mittent breathing. 
Claustrophobia. — A  fear  of  confined  spaces. 
Clinical  (literally  "  by  the  bedside  "  ).— What 

the  physician  observes  in  the  patient 
Clonic  spasm. — Spasmodic  shaking  of  limbs. 
Coccyx. — The  last  bone  of  the  spine. 
Conjunctiva. — The  mucous  membrane  covering 

the  eye. 
Demoniac  state. — A  condition  of  hysteria  with 

violent  movements  and  contortions. 
Dermatoses. — Diseases  of  the  skin. 
Diabetes. — A  wasting  disease  with  sugar  in 

the  urine. 
Diathesis. — Temperament 


A  SHORT   GLOSSARY  175 

Dominants, — Controlling  ideas  that  determine 

the  conduct. 
DyscBsthesia. — I  nsensibility. 
Dysphagia. — Difficulty  of  swallowing. 
Dyspnoea. — Difficult  respiration. 
Dysuria. — Difficult  in  urinating. 
Ecchymoses. — Effusion  of  blood  under  the  skin. 
Ecstatic  state. — A  rigid  position  with  a  fixed 

smile. 
Exophthalmic    goitre. — Swollen     neck     with 

protruding  eyes. 
Faradisation.  —  Using    the    faradic    electric 

current. 
Flatus. — Wind  in  the  intestines. 
Floating  kidney. — A  loosely  attached  kidney, 

that  is  freely  movable. 
Galvanism. — Electricity    with    the    constant 

current. 
Gangrene. — Mortification. 
Gastralgia. — Pain  in  the  stomach. 
Goitre. — Enlargement  of  the  neck. 
Hcematemesis. — Vomiting  of  blood. 
Hemiplegia. — Paralysis  of  half  the  body. 
Hypercemia. — Excess  of  blood  in  a  part, 
Hypercesthesia. — Excessive  sensibility. 
Hypnotism. — The     production     of     artificial 

sleep  without  drugs. 


176  A   SHORT   GLOSSARY 

Hypochondria. — An  apprehension  of  disease. 
Hysteria  (^Emotional). — A    nervous   disorder 

with  fits  and  anaesthesia. 
Hysteria     {Imitative). — Another     word     for 

neuromimesis. 
Ideo-motor. — Movement  resulting  from  ideas. 
Ideo-sensory. — Feelings  aroused  by  ideas. 
Incontinence. — Loss  of  power  over  the  bladder. 
Incoordination. — Want  of  harmony  in  muscle 

action. 
Inguinal. — Connected  with  the  groin. 
Insomnia. — Loss  of  sleep. 
Intermittent.  —  Irregular     (action     of    heart, 
pulse,  etc.). 

Lesion. — An  injury  to  a  part 

Malingering. — S  ham  m  in  g. 

Monophobia. — Fear  of  being  alone. 

MusccB  volitantes. — Specks  floating  before  the 
eyes. 

Mutism. — Dumbness. 

Myopia. — Short  sight 

Nascent. — Just  born. 

Neurasthenia. — Nerve  weakness. 

Neuromimesis. — N  erve  mimicry. 

Neuropath. — Nerve  sufferer. 

Neuroses. — Affections  of  the  nerves. 

Neurotic. — Nervous. 


A  SHORT   GLOSSARY  177 

(Edema. — A  swelling  of  any  kind. 

Optic  nerve. — The  nerve  of  sight. 

Paraplegia. — Paralysis  of  lower  half  of  body. 

Paresis. — Loss  of  power. 

ParcBsthesia. — I  mperfect  sensation. 

Pathology. — The  study  of  disease. 

Peripheral. — To  do  with  the  external  surface. 

Phonate. — To  make  a  vocal  sound. 

Placebos. — Medicines  given  to  satisfy  the 
mind. 

Polyuria. — Excessive  urination. 

Potfs  disease — Disease  of  the  bones  of  the 
spine. 

Prognosis. — Foretelling  the  course  of  a  disease. 

Prophylaxis. — Precautionary  measures  against 
disease. 

Pruritus. — Irritation  of  the  skin. 

Psychotherapy. — Mind-healing. 

Pyrexia. — Fever. 

Retention. — An  affection  of  the  bladder. 

Retina. — The  nervous  structure  at  the  back 
of  the  eye  that  receives  visual  impres- 
sions. 

Stigmata. — Marks  in  the  skin  produced  by 
hysteria. 

T actus  eruditus. — An  educated  touch. 

Tetany. — Lock-j  aw. 

12 


178  A  SHORT  GLOSSARY 

Tonic  spasm. — A    fixed   convulsive   state  of 

limbs. 
Ultra-red. — Invisible   heat   rays    beyond   the 

red  end  of  the  spectrum. 
Ultra-violet. — Invisible  chemical  rays  beyond 

the  violet  end  of  the  spectrum. 
Urticaria. — Nettle  rash. 
Vague  state. — A  condition  of  clouded  mind. 
Vascular  tension. — Pressure  of  blood  in  the 

arteries. 
Vertex. — The  top  of  the  head. 
Viscera. — Internal  organs. 
"  Weir-Mitchell  curer — A  system  of  putting 

on  flesh  while  in  bed. 


INDEX 


Action  and  thought  similar,  34 

of  mind  unconscious  in  hysteria,  1 5 

of  organs  of  special  sense,  23 

of  unconscious  mind,  20 

■  shows  mind,  17 

Advantages  of  auto-suggestion,  123 
^Etiology  of  nerve  disease,  45 
After  cure  of  neurasthenia,  158 

treatment  of  nerve  cases,  151 

Alcohol  and  neurasthenia,  54 

Allbutt,  Professor,  on  difficulty  in  failures,  137 

on  neurasthenia,  24 

. on  neurasthenics,  53 

Anaesthesia,  mental,  102-3 

Aphonia,  hysterical,  cure  of,  79 

Artificial  and  natural  therapeutics,  97 

Attention  to  details  in  functional  nerve  disease,  136 

Atoms  in  nerve  molecule,  34 

Auditory  and  dental  nerves,  35 

Automatic  nerve  centres,  34 

Auto-suggestion  and  nerve  affections,  1 24 

Bernheim,  124 

illustration  of,  124 

Liebeault,  124 

179 


i8o  INDEX 

Auto-suggestion  not  hypnotism,  123 
power  of,  123 

Babinski  on  hypnotism,  164 

Bad  treatment,  three  causes  for,  12 

Bed,  value  of  a  day's  rest  in,  125 

Bernheim  on  auto-suggestion,  124 

Best  suggestions,  directions  about,  1 48 

Blame  due  to  patient's  conduct,  13 

B.  M.J.  and  quacks,  112 

Bodily  sufferings  of  functional  nerve  disease,  23 

Body  and  brain,  re-making  of,  163 

less  used,  4 

no  development  of,  4 

Book,  object  of,  8 

Brain,  cause  of  hysterical  pain  in,  63 

centres  of  functional  nerve  disease,  44, 

economical  value  of,  4 

nervous  structures  in,  33 

power,  repose  of,  59 

seat  of  hysteria  is  in,  61 

strain  increasing,  3 

Brodie,  Sir  B.,  on  hysterical  joint  disease,  71 

on  spine  disease,  72 

Browne,  Sir  J.  C,  on  imagination,  95 
Bruce,  Dr.  M.,  on  vis  medicatrix  natures,  99 
Building  up  of  new  brain,  170 
Butcher  suffering  from  idea,  42 
Buzzard,  Dr.,  on  hysteria,  70 

Case  of  a  nervous  mother,  1 1 
Cases  of  hysterical  tumour,  76 
Cause  of  hysterical  pain  in  brain,  63 
of  nerve  irritation,  58 


INDEX  l8i 

Cause  of  neurasthenia  not  rush  of  life,  54 

removed  by  patient,  1 16 

to  be  removed  in  neurasthenia,  153 

Causes  for  bad  treatment,  12 

of  functional  nerve  diseases,  45 

of  hysteria,  51,  69 

of  neurasthenia,  51 

of  neuromimesis,  51 

of  pain  in  little  finger,  41 

Change  in  treatment  needed,  12 
Character  and  tact,  167 
Charcot  on  hypnotism,  164 

on  hysteria,  51 

Check  beginning  in  neurasthenia,  159 
Chiniquy,  Pastor,  and  typhoid  fever,  119 

second  cure  of,  120 

Cinderella  of  medical  science,  166 
Circle,  the  vicious,  161 
Classes  of  neurasthenics,  26 

of  neurasthenics  by  K.  Petr6n,  53 

Classification  of  neurasthenia,  57 
Clever  people,  neurasthenia  in,  52 
Clinique,  description  of,  107 
Coleridge  on  nerve  disease,  96 
Common  sense,  success  due  to,  1 52 
Conduct  determined  by  dominant  ideas,  1 24 

of  patients  often  to  blame,  13 

Confidence  in  doctor  and  nurse,  138 
Conscious  and  unconscious  minds,  16,  VJ 

self-treatment,  103 

effort  and  heart,  20 

mind,  insanity  disease  of,  67 

like  spectrum,  18 

used  as  life,  19 


production  of  nervous  mimicry,  22 


i8a  INDEX 

Consciousness  and  respiration,  20 

controls  three  systems,  20 

is  not  mind,  17 

is  visible  mind,  16 

mind  excels  beyond,  21 

produces  no  organic  change,  19 

Consulting  physician,  cures  of,  91 
Cultivation  of  will  increases  power,  122 
Curative  symptoms  of  vis  medicatrix  naturcB,  109 
Cure  and  diagnosis,  113 

by  ideal  centres,  167 

by  will  power,  119 

depends  on  quality  of  nursing  homes,  144 

ill-health  more  costly  than,  141 

more  difficult  in  functional  nerve  disease,  1 10 

must  be  adequate,  140 

natural  powers  of,  98 

of  disease  by  patient,  115 

of  hysterical  aphonia,  79 

of  hysterical  paralysis,  Dale  on,  73 

of  hysterical  tumour,  77 

of  spasm  of  gullet,  78 

psychic  powers  of,  95 

Cures  affected  by  unconscious  mind,  166 

and  public,  113 

fixed  systems  of,  140 

machine-made,  useless,  139 

of  consulting  physician,  on,  91 

Weir-Mitchell,  138,  148 

Cycling  and  golfing  in  nerve  cases,  152 

Dale,  Dr.,  on  cure  of  hysterical  paralysis,  73 

Davy,  Sir  H.,  mental  cure  by,  loi 

Death  from  fear,  103 

may  be  caused  by  hysteria,  78,  81 


INDEX  i6j 

Dearth  of  nerve  nurses,  reason  of,  142 
Debility  of  nerves,  treatment,  156 
Description  of  a  clinique,  107 

of  a  nerve  sufferer,  8 

of  neurasthenia  and  neuromimesis,  31-83 

Details  of  neurasthenia,  50 

Diagnosis  of  hysterical  joint  disease  71 

— —  of  hysterical  tumour,  ^^ 

-^—  versus  cure,  1 1 3 

Difficulty  in  treating  failures,  137 

Directions  about  suggestions,  1 56 

Disease,  cure  of,  by  patient,  1 15 

of  joint  in  hysteria,  31 

of  nerves,  functional  and  organic,  28 

organic,  mistaken  for  hysteria,  i6i 

symptoms  of  organic  nerve,  29 

treated  by  a  patient,  118 

Diseases  of  imagination  and  imaginary  disease   6   14 

131 

various  hysterical,  29 

Disorder  of  mind  not  mental  suffering,  22 
Disorders,  functional  nervous,  1-29 
Distinct  disease,  nerve  irritation,  59 
Distribution  of  functional  nerve  diseases,  3 
Doctor  and  his  medicine,  89 
— —  and  nervous  patient,  9 

increases  home  persecution,  10 

in  therapeutics,  95 

in  vis  medicatrix  natures,  109,  ill 

personality  of,  go,  151 

Doctors  and  homes,  144 

should  they  own  nursing  homes  ?  144 

Domestic  treatment  of  functional  nerve  diseases,  12$ 
Dominant  ideas  determine  conduct,  123 
Door-bell  as  illustration,  40,  63,  64 


i84  INDEX 

Drugs  and  functional  nerve  diseases,  92 

in  sleeplessness,  156 

vis  tnedicatrix  ?taturcE  greater  than,  100 

Dyspepsia  and  nervous  disease,  161 

Early  stage  of  nerves  in  patient,  117 
Economical  importance  of  brain,  4 
Economy,  short-sighted,  in  illness,  141 
Education  in  neurasthenia,  52,  53 
Electricity,  value  of,  168 
Emotional  hysteria,  symptoms  of,  65 
Emotion  and  neuromimesis,  45 
Empirical  treatment  and  common,  1 14 
Environment  changed  by  patient,  117 
Essay  on  nervous  mimicry.  Sir  J.  Paget's,  21 
Examples  of  mental  therapeutics,  10 1 

of  neuromimesis,  typical,  71 

Existing  and  living,  19 
Expense  of  nerve  treatment,  143 
Experience  in  medicine,  129. 

Failures,  difficulty  in  treating,  137 
Faith  and  hope,  value  of,  91 
Faith-healing  and  mental  therapeutics,  87 
Family  physician,  value  of,  96 

treatment  of  nerve  sufferer,  8 

Fear  of  losing  reason  unfounded,  24 
Feeling  and  memory,  39 

and  thinking,  36 

Finger,  pain  in,  40 

Firmness  in  disease  of  unconscious  mind,  135 

need  of,  in  functional  nerve  disease,  134 

Five  laws  of  health  to  be  observed  in  neurasthenia,  155 
Fixed  systems  of  cure  bad,  14.6 


INDEX  185 

Fleury,  De,  on  mind  healing,  93 

Foolish  specialist,  1 1 

Forbes,  Sir  J.,  mental  curative  qualities,  95 

France  and  America  pioneers  in  treatment  of  functional 

nerve  disease,  5 
Fraudulent  appearance  of  symptoms,  13 
Functional  and  organic  nerve  disease,  28 

nervous  disorders,  1-29 

nerve  disease  and  brain  centres,  44 

and  difficulty  in  cure,  1 10 

and  drugs,  92 

and  House  of  Education,  48 

and  ill-health,  49 

—  and  mental  idleness,  47 

and  pain,  44 

and  quacks,  1 12 

and  school-girls,  47 

and  worry,  46 

attention  to  details  in,  136 

bodily  sufferings  of,  23 

causes  great  suffering,  22 

causes  of,  45 

distribution  of,  3 

domestic  treatment  of,  125 

France  and  America  pioneers  on,  $ 

guide  to  treatment  in,  157 

hereditary  predisposing  cause  of,  45 

honesty  in  treating,  136 

increase  of,  3 

medical  cause  of,  46 

treatment  of,  127,  171 

need  of  patience  in,  132 

of  perseverance  in,  133 

of  sympathy  in,  130 

of  tact  in,  134 


i86  INDEX 

Functional  nerve  disease,  neglect  of  study  of,  J 

personal  factor  in,  139 

physical  causes  of,  48 

routine  treatment  of,  5 

Sir  J.  Paget  on,  131 

success  in  treatment  of,  129 

suffering  unparalleled,  23 

Gerbe,  mental  cure  by,  loi 

Globus  in  hysteria,  65 

Good  influences  of  healthy  brain,  167 

nursing  home,  points  in,  145 

treatment  mostly  empirical,  1 14 

Guide  to  treatment  in  functional  nerve  disease,  157 
Gullet,  cure  of  spasm  in,  78 

Healing,  mental  qualities,  94 

Health,  five  laws  observed  in  neurasthenia,  155 

is  unstable  equilibrium,  44 

Healthy  brain  exercises  good  influence,  167 

Heart  and  conscious  effort,  20 

Hereditary  predisposing    cause    ot    functional    nerve 

diseases,  45 
Hercules  and  lole,  89 
Herman  on  hypochondria,  25 
Home  persecution  increased  by  doctor,  10 
Homes  for  nursing,  143 

Honesty  in  treating  functional  nerve  diseases,  136 
House  of  Education  and  functional  nerve  diseases,  48 
Hypnotism  and  auto-suggestion,  123 

Babinski  on,  164 

Charcot  on,  164 

in  hysteria,  163 

Richet  on,  164 

Hypochondria  and  neurasthenia,  25 


INDEX  lb; 


Hypochondria,  Dr.  Herman  on,  25 
Hysteria  and  insanity,  67 

and  joint  disease,  71 

and  malingering,  7 

and  neuromimesis,  60 

and  religion,  170 

and  suppressed  gout,  69 

attacks  of,  65 

causes  of,  51,  69 

causes  organic  disease,  81 

Charcot  on,  51 

■  Dr.  Buzzard  on,  70 

•  Dr.  Reynolds  on  drugs  in,  i68 

emotional  symptoms  of,  65 

fits  of,  65 

•  globus  in,  65 
—  in  hypnotism,  163 

in  ill-balanced  brain,  68 

m«y  cause  death,  78,  81 

•  mimetic,  66 

neuromimesis  is  not,  68 

not  shamming,  7 

organic  disease  taken  for,  161 

pain  common  symptom  of,  63 

proper  use  of,  27,  61 

seat  of,  in  brain,  61 

Sir  J.  Paget  on,  7 

sudden  cures  possible  in,  74 

suggestions  in,  149 

symptoms  of,  65,  8l 

travel  in,  162 

treatment  of,  146 

used  for  neuromimesis,  27,  61 

very  common,  62 

word  wrongly  used,  6,  i'^,  27.  &' 


i88  INDEX 

Hysterical  anaesthesia,  102 

aphonia,  cure  of,  78 

diseases,  various,  79 

joint  disease,  diagnosis,  71 

mistakes  in,  71 

Sir  B.  Brodie  on,  71 

Sir  J.  Paget  on,  71 

pain,  cause  in  brain,  63 

paralysis,  72,  loi 

common,  75 

cure  of,  72 

Dr.  Reynolds  on,  72 

varieties  of,  75 

patients  are  not  mental,  51 

— ^  spasm  of  gullet,  cure  of,  78 

spine  disease,  Brodie  on,  72 

tumour,  cases  of,  76 

cure  of,  77 

diagnosis  of,  77 

symptoms  ot,  76 


tumours,  75 

vomiting,  79 

Hysterics  not  fraudulent,  71 

Ideal  centres,  cure  by,  167 

vibration  of,  36 

nerve  centres,  34 

vibrations,  37 

Ideas  in  suggestion  not  too  difficult,  165 

start  real  feelings,  36 

Idlers  and  neuropaths,  26 

Ignorance  of  mental  therapeutics,  113 

Ill-balanced  brain,  hysteria,  68 

Ill-health  and  functional  nerve  diseases,  48 

more  costly  than  any  cure,  141 


INDEX  189 

illustration  of  auto-suggestion,  124 

of  door-bell,  40,  63,  64 

of  need  in  perseverance,  134 

Illustrations  of  self-cure,  119 

of  unconscious  sensations,  38 

Imaginary  disease  and  diseases  of  imagination,  6, 14, 131 

sufferings  are  not,  12 

Imagination,  Sir  J.  C.  Browne  on,  95 
Importance  of  understanding  value  of  nerves,  4 
Increase  in  brain  strain,  3 

of  functional  nerve  disease,  3 

of  scientific  teaching,  1 1 5 

Indirect  suggestion  best,  148 
Insanity  and  hysteria,  67 

disease  of  conscious  mind,  67 

Instinct  is  a  safeguard,  20 
Intellect  and  neuromimesis,  44 
Invalids,  nervous,  cruelly  treated,  6,  7»  8 
lole  and  Hercules,  89 
Irritability  and  nervousness,  57 
Irritation  of  nerves,  58 
Isolation,  value  of,  148 


LiEBEAULT  on  auto-suggestion,  124 
Little  finger,  causes  of  pain  in,  41 
Lives  used  by  conscious  minds,  19 
Living  and  existing,  19 

Machine-made  cures  useless,  139 
Malingerers,  80 
Malingering  and  hysteria,  7 
Malnutrition  and  neuromimesis,  147 
Man  as  a  whole,  93 
Manner  in  medicine,  91 


I90  INDEX 

Massage,  value  of,  147 
Matron  of  nursing  home,  145 
Meaning  of  neurasthenia,  25 

of  vibration  of  nerves,  36 

Medical  science,  Cinderella  of,  166 

treatment  of  functional  nerve  disease,  127,  I/I 

Medicine,  doctor  and  his,  89 

•  experience  in,  129 

Memory  and  feeling,  39 
Mental  anaesthesia,  102 

cases,  rest  in  bed  in,  146 

causes  of  functional  nerve  disease,  46 

curative  qualities,  Sir  J.  Forbes  on,  95 

cure  by  Dr.  R.  Gerbe,  loi 

by  Sir  H.  Davy,  loi 

healing  by  Dr.  Morrison,  94 

hysterical  cases  not,  5 1 

idleness  and  functional  nerve  disease,  47 

medicine,  prejudice  against,  88 

origin  of  nervous  mimicry,  2 1 

suffering  is  not  mental  disorder,  22 

therapeutics,  85,  103 

act  in  all  diseases,  100 

and  faith-healing,  87 

and  systems  of  medicine,  1 14 

. and  unconscious  mind,  165 

essential,  87 

examples  of,  1 01 

ignored,  1 13 

natural  and  artificial,  97 

not  studied  scientifically,  87 

range  of,  164 

— —        ■  suggestion  on,  164 

■- varieties  of,  97 

--^—  vomiting,  103 


INDEX  191 

Methods  of  cure  must  be  adequate,  140 
Mind  action  unconscious  in  hysteria,  15 

extends  beyond  consciousness,  21 

healing,  De  Fleury  on,  93 

in  medicine  not  studied,  88 

is  not  consciousness,  17 

is  one,  16 

not  all  visible,  17 

seen  in  actions,  17 

unconscious,  functional  nerve  disease  due  to,  135 

Minds,  conscious  and  unconscious,  16,  17 
Mistakes  in  hysterical  joint  diseases,  72 

in  treatment,  160 

Morrison,  Dr.,  on  mental  healing,  94 

Natural  and  artificial  mental  therapeutics,  97 

powers  of  cure,  98 

Need  of  confidence  in  doctor  and  nurse,  138 
— —  of  firmness  in  functional  nerve  disease,  134 

of  sympathy  in  physician,  131 

of  tact  in  functional  nerve  disease,  134 

Neglect  of  study  of  functional  nerve  disease,  5 
Nerve  affections  and  auto-suggestions,  124 

cases,  after-treatment  of,  151 

cycling  and  golf  in,  152 

centres,  automatic,  34 

ideal,  34 

terminal,  34 

disease,  Coleridge  on,  96 

functional  and  organic,  28 

irritation  a  distinct  disease,  59 

cause  of,  58 

symptoms  of,  58 

mimicry  and  unconscious  mind,  44 

molecules,  atoms  in,  34 


192  INDEX 

Nerve  nurses,  born,  not  made,  142 

none  trained,  141 

reason  of  dearth  of,  142 

sufferer,  description  of,  8 

sufferers  seldom  lose  reason,  24,  125 

treatment,  expense  of,  143 

Nerves,  normal  action  of,  33 

of  motion,  34, 

of  sensation,  34 

Nervous  debility,  57 

symptoms  of,  60 

treatment  of,  1 56 

value  of  rest  in  bed  in,  156 

disease  and  dyspepsia,  161 

increase  of  functional,  3 


disorders,  functional,  1-29 
invalids  cruelly  treated,  67 
irritability,  57 
mimicry  is  mental,  21 

not  consciously  produced,  22 

Sir  J.  Paget  on,  21 


mother,  case  of,  1 1 

patient  and  doctor,  9 

and  specialist,  10 

turning-point  in  her  life,  10 

people  salt  of  the  earth,  49 

sketch  of,  49 


suffering,  tortures  of,  9 

Nervousness,  57 

is  not  hysteria,  68 

Neurasthenia,  after-cure  of,  158 

and  alcohol,  54 

——  and  hypochondria,  25 

and  neuromimisis  described,  31-83 

— —  and  other  diseases,  54 


INDEX  193 


Neurasthenia,  causes  of,  5 1 

check  beginnings  in,  1 59 

details  of,  50 

foreign  travelling,  155 

in  clever  people,  52 

in  education,  52,  53 

meaning  of,  25 

not  due  to  rush  of  life,  54 

observe  five  laws  of  health  in,  155 

pharmacy  in,  157 

Professor  Allbutt  on,  24 

proper  treatment  of,  146,  153 

remove  cause  in,  153 

symptoms  of,  56 

two  stages  of,  57 

varieties  of,  25 

Neurasthenic  nurses  do  not  exist,  142 

symptoms,  classification  of,  57 

Neurasthenics  and  neuromimetics,  24 

classes  of,  26 

Professor  Allbutt's  classification  of,  54 

Neuromimesis  and  emotions,  45 

and  hysteria,  60 

and  intellect,  44 

and  malnutrition,  147 

causes  of,  5 1 

the  term  "  hysteria  "  used  for,  27,  61 

symptoms  of,  66,  82,  83 

treatment  of,  1 59 

typical  examples  of,  71 

very  common,  62 

Neuropaths  and  idlers,  26 
New  brain,  building  up  of,  170 
Nitrogen  like  suggestion,  148 
Normal  action  of  nerves,  33 


194  INDEX 

No  study  of  mind  in  medicine,  88 

Nurse  and  doctor,  need  of  confidence  in,  138 

cured  of  typhoid,  121 

Nurses,  no  trained  nerve,  141 
Nursing  home,  matron  of,  145 

points  in  a  good,  145 

homes  and  doctors,  144. 

on,  143 

Object  of  work,  8 

Observe  five  laws  of  health  in  neurasthenia,  155 

Organic  and  functional  nerve  disease,  28 

change  not  produced  by  consciousness,  19 

disease  caused  by  hysteria,  81 

mistaken  for  hysteria,  161 

Organs  of  special  sense,  action  of,  33 
Overwork  and  strain,  48 


Paget,  Sir  J.,  on  functional  nerve  disease,  131 

on  hysteria,  7 

on  hysterical  joint  disease,  71 

on  nervous  mimicry,  21 

Pain  always  felt  in  brain,  40 

and  functional  nerve  disease,  44 

common  symptom  of  hysteria,  62 

in  little  finger,  40 

is  a  mental  impression,  43 

produced  by  suggestion,  169 

referred  to  origin  of  nerve,  40 

without  physical  origin,  43 

Paralysis,  hysterical,  72,  10 1 

Parkes  on  treatment  of  functional  nerve  disease,  6 
Patience  in  physician  in  functional  nerve  disease,  13: 
Patient  and  early  stage  of  nerves,  117 


INDEX  195 

Patient  can  change  environment,  117 

can  do  much,  115 

can  exert  will-power,  119 

can  often  treat  disease,  1 18 

can  remove  cause,  116 

cure  of  disease  by,  1 1 5 

Patient's  conduct  often  to  blame,  13 

personality,  study  of,  139 

relief  when  understood,  14 

Perseverance,  illustration  of  need  for,  134 

in  physician  in  functional  nerve  disease,  133 

factor  in  functional  nerve  disease,  139 

Personality,  Dr.  Sutton  on,  89 

of  doctor,  90,  1 5 1 

of  patient,  139 

Petr6n,  Karl,  summary  of  neurasthenic  classes,  53 
Pharmacy  in  neurasthenia,  157 
Physical  causes  of  functional  nerve  disease.  48 
Physician,  need  of  patience  in  the,  132 

of  perseverance  in  the,  133 

of  sympathy  in  the,  130 

wields  two  forces,  89 

Points  in  a  good  nursing  home,  149 
Power  of  auto-suggestion,  123 

of  emotions  in  neuromimesis,  45 

of  intellect  in  neuromimesis,  44,  45 

of  psychotherapy,  93 

of  self-suggestion,  123 

of  unconscious  mind,  92 

of  will  increased  by  cultivation,  122 

Predisposing  cause  of  functional  nerve  disease,  45 

Prejudice  against  mental  medicine,  88 

Production  of  nervous  mimicry  impossible  consciouslyj 

22 
Proof  of  mind  not  consciousness,  17 


196  INDEX 

Proper  use  of  hysteria,  27,  61 
Psychic  and  rational  treatment,  166 

powers  of  cure,  95 

Psychotherapy,  power  of,  93 
Public  and  cures,  1 13 

Quacks  and  British  Medical  Journal,  112 

and  functional  nerve  disease,  112 

why  they  flourish,  112 

Quality  of  nursing  home  determines  cure,  144 

Range  of  mental  therapeutics,  164 
Rational  and  psychic  treatment,  166 
Real  feelings  started  by  ideas,  36 
Reasonable  action  of  unconscious  mind,  20 
Reason  for  dearth  of  nerve  nurses,  142 

of  non-study  of  mental  medicine,  88 

seldom  lost  by  nerve  sufferers,  24,  125 

Relief  when  patient  is  understood,  14 
Religion  and  hysteria,  170 
Re-making  of  body  and  brain,  163 
Remove  cause  in  neurasthenia,  153 
Repose  sign  of  brain  power,  59 
Respiration  and  consciousness,  20 
Rest  in  bed  in  mental  cases,  146 

value  of  a  day's,  125 

value  of,  in  nervous  debility,  1 56 

Restored  action  of  vis  medicatrix  naiurcB,  1 1 1 
Richet  on  hypnotism,  164 

Ridicule  of  functional  nerve  disease  out  of  place,  6 
Routine  treatment  of  functional  nerve  disease,  5 
Russell  Reynolds,  Dr.,  on  drugs  in  hysteria,  168 

Safeguard  of  instinct,  20 

Salt  of  the  earth  are  nervous  people,  49 


INDEX  197 

School-girls  and  functional  nerve  disease,  47 
Scientific  study  of  mental  therapeutics,  87 

teaching  increasing,  115 

Seat  of  hysteria  is  in  brain,  61 
Second  cure  of  Pastor  Chiniquy,  120 
Self-control  should  not  be  lost,  118 

suggestion,  power  of,  123 

treatment,  conscious  and  unconscious,  105-26 

Sensations,  unconscious,  38 
Shamming,  hysteria  is  not,  7 
Short-sighted  economy  in  illness,  141 
Should  doctors  have  nursing  homes  ?  144 
Six  varieties  of  nerve  structure  in  brain,  33 
Sketch  of  nervous  people,  49 
Sleeplessness,  drugs  in,  156 
Sound  mind  feels  suffering  most,  22 
Spasm  of  gullet,  hysterical,  cure  of,  78 
Specialist  and  nerve  patient,  10 
Special  sense,  action  of  organs  of,  33 
Spectrum,  conscious  mind  like,  18 
Spinal  disease,  hysterical,  72 
Stages  of  neurasthenia,  57 
Strain  and  overwork,  48 

on  body  less,  4 

Study  of  functional  nerve  disease  neglected,  $ 

of  patient's  personality,  139 

Subconscious  mind  and  spectrum,  18 
Success  due  to  common  sense,  152 

in  treatment  of  functional  nerve  disease,  129 

Successful  treatment  due  to  vis  medicatrix  naturce,  108 
Sudden  cures  possible  in  hysteria,  74 
Sufferers  from  functional  nerve  disease  cruelly  treated,  6 
Suffering  most  felt  by  sound  mind,  22 

not  imaginary,  12 

of  butcher  from  idea,  42 


198  INDEX 

Sufferings,  bodily,  of  functional  nerve  disease,  23 

of  functional  nerve  disease,  22 

of  functional  nerve  disease  unparalleled,  23 

Suggestion,  directions  about,  148 

like  nitrogen,  148 

ideas  in,  not  too  difficult,  165 

in  hysteria,  149 

in  mental  therapeutics,  164 

produces  pain,  169 

Summary  of  classes  of  neurasthenics  by  K.  Petr6n,  53 
Suppressed  gout  and  hysteria,  69 
Supra-conscious  mind  and  spectrum,  18 
Sutton,  Dr.,  on  personality,  89 
Sympathy  in  hysteria,  65 

in  physician,  need  of,  130 

Symptoms,  curative,  of  vis  medicatrix  naturce,  109 

of  emotional  hysteria,  65 

of  functional  nerve  disease,  29 

.  of  hysteria,  81 

of  hysteria.  Dr.  Buzzard  on,  70 

of  hysterical  tumour,  76 

of  mimetic  hysteria,  66 

of  nerve  irritation,  58 

of  nervous  debility,  60 

of  neurasthenia,  56 

of  neuromimesis,  66,  82,  83 

often  appear  fraudulent,  13 

Systems  of  fixed  cures  bad,  140 

of  medicine  and  mental  therapeutics,  1 14 

three,  controlled  by  consciousness,  20 

Tact  needed  in  functional  nerve  disease,  134 
Teeth  on  edge,  35 
Terminal  nerve  centres,  34 
Therapeutics,  doctor  in,  95 


INDEX  199 

Therapeutics,  mental,  85-103 

essential,  87 

example  of,  loi 

not  studied,  87 

the  will  in,  95 

Thinking  and  feeling,  36 
Thought  and  action  similar,  34 

turning,  150 

Thoughts  and  vibrations,  39 
Three  causes  for  bad  treatment,  12 

systems  controlled  by  consciousness,  20 

Torture  of  nerve  sufferers,  9 
Trained  nerve  nurses  not  found,  141 
Transference  of  sensation  in  nerves,  35 
Travel  in  hysteria,  162 

in  neurasthenia,  155 

Treatment  at  home  of  functional  nerve  disease,  125 

change  in,  needed,  12 

lightly  dismissed,  108 

medical,  of  functional  nerve  disease,  127-71 

mistakes  in,  160 

mostly  empirical,  1 14 

of  failures,  difficulty  of,  137 

of  functional  nerve  disease,  guide  to,  157 

of  functional  nerve  disease,  success  in,  129 

of  hysteria,  146 

of  nerves,  expense  of,  143 

of  nervous  invalid  by  family,  8 

of  nervous  invalid,  cruel,  6,  7,  8 

of  neurasthenia  proper,  146,  153 

of  neuromimesis,  159 

of  rational  and  psychic,  166 

of  routine,  of  functional  nerve  disease,  5 

Treves,  Sir  F.,  on  vis  medicatrix  natures^  io8 
Turning  of  thoughts,  150 


200  INDEX 

Two  forces  of  physician,  89 

stages  of  neurasthenia,  57 

Typhoid  fever  cured  by  will,  12I 

nurse  cured  of,  121 

Pastor  Chiniquy  and,  1 19 

Typical  examples  of  neuromimesis,  71 

U^'C0NSCI0us  action  ot  mind  in  hysteria,  15 

and  conscious  self-treatment,  105,  126 

and  conscious  minds,  16 

mind,  action  always  reasonable,  20 

and  mental  therapeutics,  165 

and  nerve  mimicry,  44 

cures  effected  through,  166 

functional  nerve  disease  due  to,  135 

must  be  recognised  by  doctor,  15 

power  of,  92 

Tjis  niedicatrix  naturcB,  action  of,  99 

sensation,  38 

vibrations,  38 

Unfounded  fear  of  losing  reason,  24 

Unity  of  mind,  16 

Unparalleled  suffering  in  functional  nerve  disease,  23 

Unstable  equilibrium  and  health,  44 

Useless  machine-made  cures,  139 

Use  of  life  by  conscious  mind,  19 

Value  of  day's  rest  in  bed,  125 

of  electricity,  168 

of  faith  and  hope,  91 

of  family  physician,  96 

— —  of  hypnotism,  149 

of  isolation,  148 

of  massage,  147 

-^—  of  nerves,  importance  of  understanding,  4 


INDEX  20I 

Value  of  nursing  homes,  144 

of  voyages,  158 

Varieties  of  hysterical  paralysis,  75 

of  mental  therapeutics,  97 

of  nerve  structure  in  brain,  33 

of  neurasthenia,  25 

Various  hysterical  diseases,  79 
Vibration  and  thoughts,  39 

ideal,  37 

of  ideal  centres,  36 

of  nerve,  meaning  of,  36 

unconscious,  38 

Vicious  circle,  the,  161 

Visible  mind  is  consciousness,  116 

mind  is  not  all,  17 

Vzs  medicatrix  natu?'CB,  97-9 

V.  M.  N.  and  curative  symptoms,  107 

and  typhoid,  122 

cause  of  successful  treatment,  108 

Dr.  M.  Bruce  on,  99 

Dr.  Wilkinson  on,  109 

greater  than  drugs,  100 

in  action  of  unconscious  mind,  99,  109 

in  action  in  functional  nerve  disease,  IIO 

morbid  in  neurasthenia,  ill 

Sir  F.  Treves  on,  108 

Vogt  on  auto-suggestion,  124 
Vomiting,  hysterical,  29 

mental,  103 

Voyage,  value  of,  158 

Weir-Mitchell  cure,  138,  146 

Why  quacks  flourish,  II 2 

Wilkinson,  Dr.,  on  vis  medicatrix  naturce^  I09 

Will  cultivation  increases  power,  122 


202  INDEX 

Will  in  therapeutics,  95 

typhoid  cured  by,  121 

Will-power,  cured  by,  iig 

exerted  by  patient,  119 

Wise  specialist  and  nerve  patient,  10 
World  ruled  by  nervous  men,  49 
Worry  and  functional  nerve  disease,  46 
Wrong  use  of  hysteria,  6,  13,  27 


RC351  Sch6 

Schofield 

Me  ■rTraa_  An d  Ijsq  r  de  r 


NOV    1  3  1908 


